Comparative study between Artery-first approach and classic approach in pancreatoduodenectomy with mesopancreas dissection

Background Cancer pancreas ranks the fourth cause of death in the cancer list in the USA. Surgical resection with negative margins is one of the most important factors influencing the survival, hence, it is considered the only and best modality of choice for achieving curative treatment. Objective The aim was to check the feasibility of Artery-first approach and to check the impact of R0 mesopancreatic margin as a prognostic factor on recurrence. Patients and methods Between 2017 and 2020, 40 patients underwent pancreatoduodenectomy for periampullary carcinoma. Of these 40 patients, 22 cases underwent classic standard approach and 18 cases underwent Artery-first approach, they were followed up for postoperative morbidity and mortality, with histopathological data focusing on R margins, especially mesopancreatic margin and postoperative recurrence. Results and conclusion Artery-first approach is a safe and feasible technique in comparison with standard classic approach in pancreatoduodenectomy with mesopancreas dissection as regards operative time, blood loss, postoperative morbidity, mortality, and hospital stay. There is no significant difference between the two groups as regards recurrence. Margins in this triangle for periampullary carcinoma in univariate and multivariate analysis.