Impact of artery-first pancreaticoduodenectomy including whole lymphadenectomy around superior mesenteric artery but preserving whole nerve plexus for resectable T3 ductal adenocarcinoma of the pancreatic head

Abstract

Introduction: Artery-first pancreatoduodenectomy (AF-PD) has a positive impact on short- and long-term outcome as compared to the conventional PD (C-PD). However, appropriate AF-PD may be still unclear when focusing on extent of lymphadenectomy, or that of nerve plexus dissection around the superior mesenteric artery (SMA). Methods: We investigated recurrence and survival in 88 patients with pancreatic ductal adenocarcinoma of the head (PDAC-H) who underwent PD. Forty-five patients underwent AF-PD with the lymphadenectomy around the SMA but without nerve plexus dissection around SMA (AF-PD group), and forty-three patients underwent PD without artery-first approach, i.e., without left side lymphadenectomy at the SMA (C-PD group). Results: The median amounts of blood loss were significantly lower in the AF-PD group than in the C-PD group (P=0.0210). The numbers of totally dissected lymph nodes were significantly greater in the AF-PD group than in the C-PD group (P=0.0165). The incidence of recurrence rate of the lymph node (LN) around SMA (No. 14 LN) was significantly lower in the AF-PD group (20%) than in the C-PD group (39.5%, p=0.045). The median survival after PD was significantly higher in the AF-PD group (40.3 months) than in the C-PD group (22.6 months, p=0.014). Conclusions: The present data showed that PD based on artery-first approach and lymphadenectomy whole around SMA but preserving whole nerve plexus in patients with T3 PDAC-H may prevent LN recurrence around the SMA and may result in longer survival.