Safety and Efficacy of First Arterial Approach in Management of Pancreatic Head Carcinoma

Abstract

Objective: This prospective investigation sought to assess the technical safety, possibility, & effect of the first arterial approach(FAA) throughout PD for pancreatic head adenocarcinoma on R0 resection rates, loss of blood during operation, duration of operation, as well as early detection of unresectable illness. Patients and Methods: 100 consecutive cases having a PD for pancreatic head adenocarcinoma at Al-Azhar University Hospitals (Jan 2023–Dec 2024) usually utilized the FAA, involved the 1st dissection & control of the common hepatic artery & SMA prior to venous dissection or pancreatic transection. 1ry results included R0 resection rate, operative time, loss of blood during operation, and proportion of early diagnosis of unresectability. 2ry results comprised postoperative complications (bleeding, delayed gastric emptying, pancreatic fistula) & short-term survival. Results: FAA was technically viable in all instances. An R0 resection has been done in eighty-eight percent(88/100) of cases. Mean loss of blood during the operation was 350±120 milliliter; mean operative time was 380±75 minutes. Unresectable illness has been detected early in ten percent (10/100) of cases, avoiding additional wide dissection. Clinically relevant pancreatic fistula(Grade B/C) was fifteen percent, bleeding following pancreatectomy was seven percent, & delayed gastric emptying was 18%. The death rate within 30-days was 2%. Conclusion: FAA in pancreatic head carcinoma is a safe and effective method for early resectability assessment, enhancing R0 resection rates, avoiding unnecessary dissection in unresectable cases, and demonstrating acceptable perioperative results, thereby warranting its implementation in specialized environments.