{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T10:11:47Z","timestamp":1791972707953,"version":"4.3.4"},"reference-count":41,"publisher":"Oxford University Press (OUP)","issue":"8","license":[{"start":{"date-parts":[[2012,5,9]],"date-time":"2012-05-09T00:00:00Z","timestamp":1336521600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2012,7,4]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>The technique of pancreatoduodenectomy (PD) has evolved. Previously, non-resectability was determined by involvement of the portal vein\u2013superior mesenteric vein. Because venous resection can be achieved safely and with greater awareness of the prognostic significance of the status of the posteromedial resection margin, non-resectability is now determined by involvement of the superior mesenteric artery (SMA). This change, with a need for early determination of resectability before an irreversible step, has promoted the development of an \u2018artery-first\u2019 approach. The aim of this study was to review, and illustrate, this approach.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>An electronic search was performed on MEDLINE, Embase and PubMed databases from 1960 to 2011 using both medical subject headings and truncated word searches to identify all published articles that related to this topic.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>The search revealed six different surgical approaches that can be considered as \u2018artery first\u2019. These involved approaching the SMA from the retroperitoneum (posterior approach), the uncinate process (medial uncinate approach), the infracolic region medial to the duodenojejunal flexure (inferior infracolic or mesenteric approach), the infracolic retroperitoneum lateral to the duodenojenunal flexure (left posterior approach), the supracolic region (inferior supracolic approach) and through the lesser sac (superior approach).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>The six approaches described provide a range of options for the early determination of arterial involvement, depending on the location and size of the tumour, and before the \u2018point of no return\u2019. Whether these approaches will achieve an increase in the proportion of patients with negative margins, improve locoregional control and increase long-term survival has yet to be determined.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1002\/bjs.8763","type":"journal-article","created":{"date-parts":[[2012,5,9]],"date-time":"2012-05-09T10:05:12Z","timestamp":1336557912000},"page":"1027-1035","source":"Crossref","is-referenced-by-count":307,"title":["\u2018Artery-first\u2019 approaches to pancreatoduodenectomy"],"prefix":"10.1093","volume":"99","author":[{"given":"P","family":"Sanjay","sequence":"first","affiliation":[{"name":"Hepatopancreatobiliary\/Upper Gastrointestinal Unit, Department of General Surgery, Auckland City Hospital, Auckland, New Zealand"},{"name":"Department of Surgery, Ninewells Hospital and Medical School, Dundee, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"K","family":"Takaori","sequence":"additional","affiliation":[{"name":"Division of Hepato-Biliary-Pancreatic Surgery and Transplantation, Department of Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S","family":"Govil","sequence":"additional","affiliation":[{"name":"Division of Gastrointestinal Oncology, Bangalore Institute of Oncology, Bangalore, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S V","family":"Shrikhande","sequence":"additional","affiliation":[{"name":"Department of Gastrointestinal and Hepatopancreatobiliary Surgical Oncology, Tata Memorial Centre, Mumbai, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J A","family":"Windsor","sequence":"additional","affiliation":[{"name":"Hepatopancreatobiliary\/Upper Gastrointestinal Unit, Department of General Surgery, Auckland City Hospital, Auckland, New Zealand"},{"name":"Department of Surgery, School of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2012,5,9]]},"reference":[{"key":"2021031607094291400_bib1","doi-asserted-by":"crossref","first-page":"733","DOI":"10.1016\/j.gassur.2004.03.005","article-title":"Pancreatoduodenectomy","volume":"8","author":"Warshaw","year":"2004","journal-title":"J Gastrointest Surg"},{"key":"2021031607094291400_bib2","doi-asserted-by":"crossref","first-page":"662","DOI":"10.1002\/bjs.5368","article-title":"Systematic review of outcome of synchronous portal\u2013superior mesenteric vein resection during pancreatectomy for cancer","volume":"93","author":"Siriwardana","year":"2006","journal-title":"Br J Surg"},{"key":"2021031607094291400_bib3","doi-asserted-by":"crossref","first-page":"154","DOI":"10.1001\/archsurg.2008.547","article-title":"Arterial and venous resection for pancreatic adenocarcinoma; 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