Comparative study between SMA-CA axis-guided anatomical approach and traditional approach in pancreatoduodenectomy

CHEN Jiang-zhi; JIN Kai-zhou; YE Long-yun; CHEN Shi; CAI Xin-ran; CHEN Yan-ling; WU We-ding

doi:10.19538/j.cjps.issn1005-2208.2025.06.14

Abstract：Objective To compare the safety and effectiveness of the superior mesenteric artery-celiac artery(SMA-CA)axis-guided anatomy(SCGA)approach with the conventional venous approach(CVA)in pancreaticoduodenectomy(PD).Methods A retrospective analysis was conducted on 294 pancreatic cancer patients who underwent PD operation between January 2021 and December 2022 at Fudan University Shanghai Cancer Hospital,Fujian Medical University Union Hospital and Fuzhou University Provincial Hospital.Among them,93 patients were in the SCGA group,and 201 patients were in the CVA group.The operation time,intraoperative blood loss,R0 resection rate,average number of examined lymph nodes,positive lymph nodes,postoperative complication rate and postoperative survival time were compared between the two groups.Results There was no significant difference in operative time between the two groups(P＞0.05).The intraoperative blood loss mL and blood transfusion volume in the CVA group were both higher than those in the SCGA group mL and[(277.86±143.94)mL vs.(243.12±125.46)mL;28.86％vs.16.13％],with significant differences(P≤0.05).The R0 resection rate in the CVA group(88.56％)was lower than that in the SCGA group(95.70％),with a significant difference(P≤0.05).The average number of examined lymph nodes and positive lymph nodes in the SCGA group were both higher than those in the CVA group(17.86 vs.15.42;1.99 vs.1.18),with significant differences(both P≤0.05).There was no significant difference in postoperative complication rate between the two groups(P＞0.05),and no significant difference in postoperative survival time between the two groups(P＞0.05).Conclusion The SMA-CA axial anatomical approach demonstrates enhanced R0 resection rates and lymph node dissection yields compared to conventional approaches,while maintaining comparable postoperative complication rates and 2-year survival outcomes.These findings confirm that the SCGA technique represents a safe and feasible surgical strategy for PD procedures.