title: Artery first approach to pancreatoduodenectomy: current status.
abstract: BACKGROUND
  The need for an early determination of resectability and before an irreversible step is taken during pancreatoduodenectomy promoted the development of an 'artery first approach' (AFA). The aim of this study was to review the current evidence related to this approach, with particular reference to margins and survival.
  
  
  METHODS
  An electronic search was performed in MEDLINE, EMBASE and PubMed databases from 1960 to 2015 using both subject headings (MeSH) and truncated word searches to identify all published related articles to this topic.
  
  
  RESULTS
  Six different AFAs have been published. Four studies evaluated the impact of AFA on perioperative outcomes and survival. Three studies showed no difference in the perioperative outcomes, margin status, lymph node yield and survival while one study showed improved margin status and survival comparing AFA with standard resection.
  
  
  CONCLUSIONS
  The current evidence regarding the benefits of AFA in relation to decreasing margin positivity or increasing survival is sparse. Further larger studies and randomized controlled trails are needed to ascertain the benefits of AFA.
authors.affiliation: HBP/Upper GI Unit, Department of General Surgery, Auckland City Hospital, Auckland, New Zealand.
authors.forename: Sanjay
authors.initials: S
authors.lastname: Pandanaboyana
authors.affiliation: Department of Hepatobiliary and Pancreatic Surgery, St James Hospital, Leeds, UK.
authors.forename: Richard
authors.initials: R
authors.lastname: Bell
authors.affiliation: HBP/Upper GI Unit, Department of General Surgery, Auckland City Hospital, Auckland, New Zealand.
authors.forename: John
authors.initials: J
authors.lastname: Windsor
mesh_terms: D001158:Arteries / Q000601:surgery*; D006801:Humans; D010190:Pancreatic Neoplasms / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000379:methods*; D059035:Perioperative Period; D016019:Survival Analysis; D016896:Treatment Outcome
keywords: Whipple's procedure; artery first; margin; pancreatoduodenectomy; superior mesenteric artery