Pancreaticoduodenectomy for borderline resectable pancreatic head cancer with a modified artery-first approach technique

BACKGROUND: The treatment of borderline resectable pancreatic head cancer(BRPHC) is still controversial and challenging. The artery-first approaches are described to be the important options for the early determination. Whether these approaches can achieve an increase R0 rate, better bleeding control and increasing long-term survival for BRPHC are still controversial. We compared a previously reported technique, a modified artery-first approach(MAFA), with conventional techniques for the surgical treatment of BRPHC.METHODS: A total of 117 patients with BRPHC undergone pancreaticoduodenectomy(PD) from January 2013 to June 2015 were included. They were divided into an MAFA group(n=78) and a conventional-technique group(n=39). Background characteristics, operative data and complications were compared between the two groups.RESULTS: Mean operation time was significantly shorter in the MAFA group than that in the conventional-technique group(313 vs 384 min; P=0.014); mean volume of intraoperative blood loss was significantly lower in the MAFA group than that in the conventional-technique group(534 vs 756 m L; P=0.043); and mean rate of venous resection was significantly higher in the conventional-technique group than that in the MAFA group(61.5% vs 35.9%; P=0.014). Pathologic data, early mortality and morbidity were not different significantly between the two groups.CONCLUSIONS: MAFA is safe, simple, less time-consuming, less intraoperative blood loss and less venous resection, and therefore, may become a standard surgical approach to PD for BRPHC with the superior mesenteric vein-portal vein involvement but without superior mesenteric artery invasion.