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Updated: Oct 18, 2025
Laparoscopic Pancreatoduodenectomy With Modified Blumgart Pancreaticojejunostomy
Published on: June 17, 2018
Pancreaticoduodenectomy at a Non-high-volume Center and Efforts to Perform Safe Surgery
Taishi Yamane1,2, Daisuke Izumi1, Shotaro Kinoshita1
1Department of Surgery, Japan Community and Health Organization Kumamoto General Hospital, Yatsusiro, Japan.
Insights
The artery-first approach (AFA) for pancreaticoduodenectomy (PD) shows promise in reducing surgery time, blood loss, and transfusion needs, particularly for pancreatic cancer patients at non-high-volume centers.
Area of Science:
- Gastroenterology and Hepatology
- Surgical Oncology
- Abdominal Surgery
Background:
- Pancreaticoduodenectomy (PD) is a complex procedure with significant perioperative risks.
- The artery-first approach (AFA) is a modified surgical technique for PD.
- Evaluating AFA's effectiveness at non-high-volume centers is crucial for broader adoption.
Purpose of the Study:
- To assess the impact of the artery-first approach (AFA) on surgical outcomes of pancreaticoduodenectomy (PD).
- To compare AFA with the conventional approach in a non-high-volume center setting.
Main Methods:
- Retrospective review of 121 consecutive PD patients (January 2009 - December 2018).
- Comparison of perioperative data between 72 AFA patients and 49 conventional PD patients.
- Statistical analysis to evaluate the effectiveness of AFA.
Main Results:
- No overall significant difference in surgical outcomes between AFA and conventional PD.
- In pancreatic cancer patients, AFA significantly reduced surgery duration (p=0.011).
- AFA also significantly decreased intraoperative blood loss (p=0.021) and transfusion rates (p=0.038) in pancreatic cancer patients.
Conclusions:
- The artery-first approach (AFA) is a viable technique for pancreaticoduodenectomy (PD).
- AFA can lead to reduced operative time, blood loss, and transfusion requirements specifically in pancreatic cancer cases.
- These benefits suggest AFA can improve surgical outcomes for pancreatic cancer patients even at centers with lower PD volumes.
Aim:
The aim of the current study was to investigate whether the artery-first approach (AFA) improved surgical outcomes of pancreaticoduodenectomy (PD) at our non-high-volume center.
Patients And Methods:
We retrospectively reviewed data on 121 consecutive patients who underwent PD between January 2009 and December 2018. The perioperative data of 49 patients who underwent conventional PD (conventional group) and 72 patients who underwent PD via artery-first approach were analyzed and compared to assess the effectiveness of the AFA.
Results:
Although no significant difference was observed between the two groups overall, in those with pancreatic cancer, the duration of surgery, intraoperative blood loss and transfusion rate in the AFA group (n=33) were significantly lower than those for the conventional group (n=11) (p=0.011, p=0.021 and p=0.038 respectively).
Conclusion:
AFA can be used to reduce the operative time, intraoperative blood loss, and transfusion rate in patients with pancreatic cancer.
