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Posterior superior mesenteric artery first dissection versus classical approach in pancreaticoduodenectomy: Outcomes of a case-matched study

Lookup NU author(s): Sanjay PandanaboyanaORCiD


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© 2017 Wolters Kluwer Health, Inc. All rights reserved.Objectives: Posterior superior mesenteric artery (SMA) first dissection in pancreaticoduodenectomy (PD) may allow for early assessment of resectability and aberrant anatomy. Study objectives were to compare resection margins, perioperative outcomes, disease-free survival (DFS) and overall survival (OS) in patients undergoing a posterior SMA first dissection PD to a classical technique PD. Methods: Patients (n = 77) who underwent a posterior SMA first PD for adenocarcinomawere casematched for patient and tumor characteristics with patients undergoing a classical approach PD from 2006 to 2014 (n = 177). Results: The SMA first patients had an improved negative resection margin rate (27 [35.1%] vs 14 [18.2%], P = 0.042) and a higher lymph node yield (median 28 [22-34] vs 21 [17-27], P < 0.001) compared with the classical approach group. No difference was demonstrated in serious complications or 30-day mortality between the SMA first and classical approach patients (Clavien-Dindo 3/4 16 [20.8%] vs 11 [14.3%], P = 0.336; 30-day mortality 3 [3.9%] vs 3 [3.9%], P = 1.00 respectively). Median DFS and OS was similar in SMA first compared with classical approach patients (DFS, 1.6 vs 1.1 years, P = 0.122; OS, 2.5 vs 1.5 years, P = 0.220 respectively). Conclusions: A posterior SMA first approach is a comparably safe technique that may improve oncological results in PD compared with classical approach dissection.

Publication metadata

Author(s): Vallance AE, Young AL, Pandanaboyana S, Lodge JP, Smith AM

Publication type: Article

Publication status: Published

Journal: Pancreas

Year: 2017

Volume: 46

Issue: 2

Pages: 276-281

Print publication date: 01/02/2017

Acceptance date: 01/09/2016

ISSN (print): 0885-3177

ISSN (electronic): 1536-4828

Publisher: Lippincott Williams and Wilkins


DOI: 10.1097/MPA.0000000000000748

PubMed id: 28060185


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