Superior mesenteric artery-first approach for borderline resectable pancreatic head cancer

Objective: To evaluate the value of superior mesenteric artery-first approach for borderline resectable pancreatic head cancer(BRPHC) Methods: According to the inclusion and exclusion criteria, the data of 203 patients with borderline resectable pancreatic head cancer(BRPHC) who underwent radical pancreatoduodenectomy in our center from January 2011 to December 2024 were retrospectively analyzed. After detecting the superior mesenteric artery in infracolic compartment to judge that there was vascular invasion but it met the borderline resection criteria, the blood supply was cut off first, then the tissues and organs were resected. And the invaded vessels were resected and reconstructed or replaced, then conventional anastomosis was performed. All patients were divided into arterial approach group and conventional approach group according to the operation method. The outcome measures were operation completion, perioperative conditions and overall prognosis. The follow-up time was up to February 2025. Results: All 203 patients successfully completed the operation without perioperative death, and confirmed as pancreatic ductal adenocarcinoma by pathological examination. Overall and grouped prognosis: The overall survival rates and disease-free survival rates of 1-, 2-, and 5-year were 51.9%, 25.0%, 8.5% and 28.4%, 12.9%, 3.9% (Figure 1). The 1-, 2-, and 5-year survival rates of patients in two groups were 62.1%, 40.3%, 21.7% and 44.1%, 14.7%, 1.8% (P=0.000, X ² =20.927) (Figure 2A); The 1-, 2-, and 5-year disease-free survival rates in two groups were 44.9%, 24.5%, 8.2% and 20.8%, 7.5%, 1.9% (P=0.006, X ² =7.457) (Figure 2B). Conclusion : The superior mesenteric artery-first approach in infracolic compartment can improve the prognosis of patients with borderline resectable pancreatic head cancer, prolong the postoperative survival time of patients, and reduce the recurrence.