Radical modular pancreatoduodenectomy for pancreatic head cancer using a combination of multiple artery-first approaches technique

The aim of this study was to describe and assess the efficacy of a combination of multiple artery-first approaches (CMAFA) in pancreatoduodenectomy (PD) depending on the tumor location from an embryonic point of view. Between January 2011 and December 2016, seventy-nine consecutive patients with pancreatic head cancer (PHC) underwent PD with curative intent. Patients were classified into two groups according to the surgical procedure: CMAFA-PD group (n=38) and conventional PD (Co-PD) group (n=41). Clinicopathlogical variables and clinical outcomes were compared among the two groups. The CMAFA technique demonstrated an improved rate of R0 resection (89.5% vs. 70.7%, P=.038) and a higher median lymph node yield (24 vs. 20, P=.034). The CMAFA-PD group was associated with reduced blood loss (450 vs. 600 ml, P=.049), lower rate of blood transfusion (23.7% vs. 46.3%, P=.035), and shorter length of hospital stay (19 vs. 26 days, P<.001). The rates of 90-day mortality, major morbidity, and readmission were comparable among the two groups. This study demonstrates that CMAFA is a feasible and efficient technique with acceptable perioperative and oncological outcomes in treating patients with PHC.