Hepatobiliary Pancreat Dis Int ; 16 2 :Apr.
Increasing evidence showed that a periadventiceal dissection of the SMA with early transection of the inflow during pancreaticoduodenectomy associates better early perioperative results, and setup the scene for long-term oncological benefits. The objectives of the current study are to compare the operative results and long-term oncological outcomes of SMA first approach pancreaticoduodenectomy SMA-PD with standard pancreaticoduodenectomy S-PD.
The SMA-PD was associated with less intraoperative bleeding, less blood transfusions and higher rate of associated venous resections. Peritoneal cancer incidence pancreatic fistula and peritoneal cancer incidence gastric emptying had a significantly lower rate in the SMA-PD group. There were no differences between the two approaches regarding overall complications, major complication rates and in-hospital mortality.
Peritoneal cancer incidence was no difference regarding R0 resection rate, and one- two- peritoneal cancer incidence three-year overall survival. Although the one- two- or three-year overall survival rate is not superior, the SMA-PD has a lower local and metastatic recurrence rate.