Artery-First Approach for Pancreatic Cancer

Early determination of superior mesenteric artery (SMA) involvement during pancreatoduodenectomy and distal pancreatectomy for pancreatic cancer before irreversible steps are taken has led to the development of artery-first approach (AFA). To date, six different artery-first approaches to cancer in the head of the pancreas and one approach to cancer in the body of the pancreas have been published. In addition to identifying SMA involvement at an earlier stage of the trial dissection, AFA enables earlier identification of RRHA and ligation of IPDA thereby reducing intraoperative blood loss. The benefits of AFA in improving margin status and survival after PD are sparse. Nevertheless, the various AFAs provide the surgeon with range of options based on the location and size of the tumour to undertake trial dissection especially in patients after neoadjuvant chemotherapy to determine SMA involvement.