Usefulness of the Artery First Approach in Pancreatic Cancer Surgery

  • End date
    Dec 31, 2023
  • participants needed
  • sponsor
    Asan Medical Center
Updated on 4 October 2022
Accepts healthy volunteers


This study is aimed to evaluate difference of the 2 year recurrence free survival after pancreaticoduodenectomy for pancreatic cancer between artery-first approach and conventional procedure groups.


The patients will be divided into 2 groups

conventional group: The patients who included this group will undergo conventional pancreaticoduodenectomy (PD) or pylorus preserving pancreaticoduodenectomy (PPPD). We will identify and isolate superior mesenteric vein (SMV) before pancreatic resection. The surgeon will dissect tissue around superior mesenteric artery (SMA) and uncinate process of pancreas along the SMA.

Experimental group:

The patients who included this group will undergo PD or PPPD including total pancreatic mesopancreas excision and superior mesenteric artery approach. Before pancreatic transection, the surgeon will isolate superior mesenteric vein (SMV) and superior mesenteric artery (SMA). And the surgeon will dissect nerve plexus and lymph node around SMA. inferior pancreaticoduodenal artery (IPDA) and first jejunal artery will be identified and the surgeon will ligate according to surgical margin. Anastomosis will be performed as usual manners.

Postoperative manage is same in two groups. The investigators will compared 2 years recurrence free survival rate between conventional and experimental groups.

Condition Pancreatic Cancer, Adult, Margin, Tumor-Free, Surgery Site Fistula, Recurrence Tumor
Treatment conventional pancreaticoduodenectomy, total mesopancreas excision including superior mesenteric artery first approach
Clinical Study IdentifierNCT04136522
SponsorAsan Medical Center
Last Modified on4 October 2022


Yes No Not Sure

Inclusion Criteria

Resectable pancreatic head cancer
No systemic metastasis
Age > 20 years
The patients who understand informed consent and is able to agree with study

Exclusion Criteria

The patients who have systemic metastasis
The patients who need neoadjuvant therapy in borderline resectable and locally advanced pancreatic cancer
Those with active or uncontrolled infections
Those with severe psychiatric / neurological disorders
Alcohol or other drug addicts
Patients with moderate or severe comorbidities who are thought to have an impact on quality of life or nutritional status (cirrhosis, chronic kidney failure, heart failure, etc.)
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