Artery first approach to pancreatic cancer is being increasingly adopted to improve perioperative outcomes. This review summarised the current evidence regarding the role of artery first approach in improving perioperative and long-term oncological outcomes. Several retrospective studies employing artery first approach to pancreatic cancer have shown increase in R0 resection rates, lymph node yield, reduced intraoperative blood loss, and prolong long-term survival. These benefits of artery first approach to pancreatoduodenectomy are worth exploring further, and this will require multi-centre studies with close attention to the consistency of artery first approach to pancreatoduodenectomy techniques and its perceived benefits. Furthermore, the increasing use of neoadjuvant (chemotherapy ± radiotherapy) strategies for pancreatic ductal adenocarcinoma is also relevant to this discussion about artery first approach to pancreatoduodenectomy. Patients who have not developed evidence of metastases are may benefit from a trial dissection using an artery first approach to determine resectability and the ability achieve an R0 margin.
Sanjay Pandanaboyana, Benjamin Loveday, John A Windsor