Vascular First, Tumor Second: A Case Series Evaluating the Artery-First Approach in Pancreaticoduodenectomy

Background: This study examines the clinical and onco-logical outcomes associated with the superior mesenteric artery (SMA) first approach in pancreaticoduodenectomy (PD) for patients diagnosed with malignancies of the pancreatic head. Aim of Study: This study aims explicitly to pilot the tech-nique’s feasibility, safety, and efficacy in comparison to the conventional approach. The research seeks to enhance the comprehension of the possible benefits and limitations of the artery-first strategy in PD by investigating these critical param-eters. Patients and Methods: In a three years retrospective case series at Gastrointestinal Surgical Center (GISC), Mansoura University Hospitals, 17 patients were examined for periop-erative parameters such operation duration, blood loss, com-plication rates, and oncological outcomes like R0 resection rates and overall survival. Improving surgical accuracy while reducing problems linked to traditional procedures is the goal of the SMA-first approach. The most common symptom was jaundice, and the individuals’ median age was 62 years old, ac-cording to the results. With normal SMA margins seen in 94.1% of patients, preoperative imaging validated the viability of the SMA-first technique. A considerable frequency of postopera-tive problems was identified in the research, with pancreatic leakage accounting for 47.1% and total difficulties for 52.9%, even though the vascular margins were clean. Only one patient died within 30 days after surgery, and the average length of stay in the hospital after the procedure was 10 days. Consist-ent with earlier research highlighting its potential benefits, the SMA-first procedure showed improvements over conventional methods in relation to blood loss and surgical efficiency. On the other hand, anastomosis procedures in particular need further improvement because to the high risk of pancreatic leakage. In this case series, the SMA-first strategy in PD is shown to be safe and effective while indicating areas for improvement to enhance pancreatic cancer surgical results. Results: The Median (IQR) age of included pancreatic head mass patients undergoing the artery-first approach was 62 (14) years. Gender distribution was nearly equal (male vs. female: 52% vs. 47.1%). The most common complaint on admission among them was jaundice (76.5%), followed by abdominal pain (47%) and loss of weight (23.5%), while fever and vom-iting were recorded only in 11.8%. Diabetes and hypertension were recognized in 7. Conclusion: This case series evaluating the artery-first approach for pancreaticoduodenectomy (PD) in patients with pancreatic head cancer demonstrates promising surgical and oncological outcomes. The technique allowed clear vascular margins in most cases, indicating its potential effectiveness in achieving R0 resections. Despite the low mortality rate and minimal intraoperative complications, the study revealed a sig-nificant incidence of postoperative complications, particularly pancreatic leakage, which underscores the need for refinement in surgical techniques, especially concerning anastomosis methods. The findings align with existing literature suggesting that while the artery-first strategy may enhance certain opera-tive parameters, further investigation is warranted to confirm its long-term benefits and to address the challenges posed by postoperative complications. Overall, this research contributes valuable insights into the feasibility and safety of the artery-first SMA approach, paving the way for future studies aimed at op-timizing outcomes for patients undergoing PD for pancreatic malignancies.