RT Journal Article
T1 Does the Artery-first Approach Improve the Rate of R0 Resection in Pancreatoduodenectomy? A Multicenter, Randomized, Controlled Trial
A1 Sabater, Luis
A1 Cugat, Esteban
A1 Serrablo, Alejandro
A1 Suarez-Artacho, Gonzalo
A1 Diez-Valladares, Luís
A1 Santoyo-Santoyo, Julio
A1 Martín-Pérez, Elena
A1 Ausania, Fabio
A1 López-Ben, Santiago
A1 Jover-Navalon, José María
A1 Garcés-Albir, Mariana
A1 García-Domingo, Maria Isabel
A1 Serradilla, Mario
A1 Pérez-Aguirre, Elia
A1 Sánchez-Pérez, Belinda
A1 Di Martino, Marcello
A1 Senra-del-Rio, Paula
A1 Falgueras-Verdaguer, Laia
A1 Carabias, Alberto
A1 Gómez-Mateo, Mari Carmen
A1 Fernández, Antonio
A1 Dorcaratto, Dimitri
A1 Muñoz-Forner, Elena
A1 Fondevila, Constantino
A1 Padillo, Javier
K1 Páncreas - Cáncer
AB Objective: To compare the rates of R0 resection in pancreatoduodenectomy (PD) for pancreatic and periampullary malignant tumors by means of standard (ST-PD) versus artery-first approach (AFA-PD).Background: Standardized histological examination of PD specimens has shown that most pancreatic resections thought to be R0 resections are R1. “Artery-first approach” is a surgical technique characterized by meticulous dissection of arterial planes and clearing of retropancreatic tissue in an attempt to achieve a higher rate of R0. To date, studies comparing AFA-PD versus ST-PD are retrospective cohort or case-control studies.Methods: A multicenter, randomized, controlled trial was conducted in 10 University Hospitals (NCT02803814, ClinicalTrials.gov). Eligible patients were those who presented with pancreatic head adenocarcinoma and periampullary tumors (ampulloma, distal cholangiocarcinoma, duodenal adenocarcinoma). Assignment to each group (ST-PD or AFA-PD) was randomized by blocks and stratified by centers. The primary end-point was the rate of tumor-free resection margins (R0); secondary end-points were postoperative complications and mortality.Results: One hundred seventy-nine patients were assessed for eligibility and 176 randomized. After exclusions, the final analysis included 75 ST-PD and 78 AFA-PD. R0 resection rates were 77.3% (95% CI: 68.4–87.4) with ST-PD and 67.9% (95% CI: 58.3–79.1) with AFA-PD, P=0.194. There were no significant differences in postoperative complication rates, overall 73.3% versus 67.9%, and perioperative mortality 4% versus 6.4%.Conclusions: Despite theoretical oncological advantages associated with AFA-PD and evidence coming from low-level studies, this multicenter, randomized, controlled trial has found no difference neither in R0 resection rates nor in postoperative complications in patients undergoing ST-PD versus AFA-PD for pancreatic head adenocarcinoma and other periampullary tumors
PB Eselvier
YR 2019
FD 2019
LK https://hdl.handle.net/10630/41438
UL https://hdl.handle.net/10630/41438
LA eng
NO Sabater L, Cugat E, Serrablo A, Suarez-Artacho G, Diez-Valladares L, Santoyo-Santoyo J, Martín-Pérez E, Ausania F, Lopez-Ben S, Jover-Navalon JM, Garcés-Albir M, Garcia-Domingo MI, Serradilla M, Pérez-Aguirre E, Sánchez-Pérez B, Di Martino M, Senra-Del-Rio P, Falgueras-Verdaguer L, Carabias A, Gómez-Mateo MC, Ferrandez A, Dorcaratto D, Muñoz-Forner E, Fondevila C, Padillo J. Does the Artery-first Approach Improve the Rate of R0 Resection in Pancreatoduodenectomy?: A Multicenter, Randomized, Controlled Trial. Ann Surg. 2019 Nov;270(5):738-746. doi: 10.1097/SLA.0000000000003535. PMID: 31498183.
DS RIUMA. Repositorio Institucional de la Universidad de Málaga
RD 20 ene 2026