Perioperative outcomes of pancreaticoduodenectomy: Superior mesenteric artery first approach in Rajavithi Hospital, Thailand

• Published in: Surgical practice 2018-05, Vol.22 (2), p.75-80
• Main Authors: Inthasotti, Wipawee, Teepongkaruna, Sa‐ard, Chaibut, Kittipong, Singhirunusorn, Jumpol, Duriyaprapan, Pornchanan, Jantarateptewan, Natcha, Subwongcharoen, Somboon
• Format: Article
• Language: English
• Subjects: left posterior approach; mesenteric approach; Pancreaticoduodenectomy; pancreatoduodenectomy; perioperative outcome; superior mesenteric artery first approach; Veins & arteries
• ISSN: 1744-1625; 1744-1633
• DOI: 10.1111/1744-1633.12303

Aim Superior mesenteric artery (SMA) first approach has been widely accepted as an effective surgical technique for en‐bloc resection in periampullary cancer. There are currently multiple different artery first approach (AFA) techniques. The aim of the present study was to assess the perioperative outcome by comparing two surgical techniques at a single institute. Patients and Methods This was retrospective study comparing consecutive patients who had undergone pancreatoduodenectomy (PD) with mesenteric and left posterior AFA between July 2012 and March 2017 at Rajavithi Hospital, Thailand. Results In total, 103 patients were included. Both groups were comparable regarding demographics, tumour characteristics and perioperative outcomes. The mean operative time was 420 min in the SMA PD group and 360 min in the left posterior artery (LPA) PD group. The mean operative blood loss in the SMA PD group and LPA PD group was 750 and 700 cc, respectively. Overall, complications occurred in 45.6 per cent of patients. Eighty‐seven patients (84.5 per cent) had negative resection margins, and the median number of lymph nodes harvested was 11 nodes in the MSA PD group and 16 nodes in the LPA group. Conclusion The AFA to PD has comparable perioperative outcomes with standard PD without increasing morbidity and mortality.