{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,18]],"date-time":"2025-10-18T10:54:55Z","timestamp":1760784895183},"reference-count":38,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2020,11,10]],"date-time":"2020-11-10T00:00:00Z","timestamp":1604966400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2020,11,10]],"date-time":"2020-11-10T00:00:00Z","timestamp":1604966400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/www.springer.com\/tdm"},{"start":{"date-parts":[[2020,11,10]],"date-time":"2020-11-10T00:00:00Z","timestamp":1604966400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/www.springer.com\/tdm"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["World j. surg."],"published-print":{"date-parts":[[2021,3]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Artery\u2010first approach pancreatoduodenectomy (AFA\u2010PD) is an important technique for treating pancreatic ductal adenocarcinoma (PDAC). However, it remains unknown whether performing complete lymphadenectomy around the entire superior mesenteric artery (SMA) is associated with better outcomes. In this retrospective study, we aimed to investigate whether this approach improved overall and recurrence\u2010free survival in patients with PDAC.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We identified 88 patients with T3\u00a0PDAC who underwent PD at St. Marianna University School of Medicine, Kawasaki, Japan, between April 2005 and October 2017. Two groups were defined: an \u201cAFA\u2010PD group\u201d (<jats:italic>n<\/jats:italic>\u2009=\u200945) who had undergone AFA\u2010PD in addition to complete lymphadenectomy around the entire SMA, and a \u201cconventional PD group\u201d (<jats:italic>n<\/jats:italic>\u2009=\u200943) in whom complete lymphadenectomy had not been performed (conventional group). Univariate and multivariate survival analyses were performed to identify risk factors for overall and disease\u2010free survival.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The AFA\u2010PD group had a longer median survival time (40.3 vs. 22.6\u00a0months; <jats:italic>p<\/jats:italic>\u2009=\u20090.0140) and a higher 5\u2010year survival rate (40.3% vs. 5.9%, <jats:italic>p<\/jats:italic>\u2009=\u20090.005) than the conventional PD group. Multivariate analysis showed that AFA\u2010PD with complete lymphadenectomy around the entire SMA was an independent factor for improved overall survival (<jats:italic>p<\/jats:italic>\u2009=\u20090.022). Recurrences around the SMA were significantly less frequent in the AFA\u2010PD group than in the conventional group (22.2% vs. 44.2%, <jats:italic>p<\/jats:italic>\u2009=\u20090.041).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>AFA\u2010PD with complete lymphadenectomy around the entire SMA can prevent recurrences around the SMA and may prolong overall survival in patients with PDAC.<\/jats:p><\/jats:sec>","DOI":"10.1007\/s00268-020-05856-w","type":"journal-article","created":{"date-parts":[[2020,11,10]],"date-time":"2020-11-10T19:02:52Z","timestamp":1605034972000},"page":"857-864","update-policy":"http:\/\/dx.doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Complete Lymphadenectomy Around the Entire Superior Mesenteric Artery Improves Survival in Artery\u2010First Approach Pancreatoduodenectomy for T3\u00a0Pancreatic Ductal Adenocarcinoma"],"prefix":"10.1002","volume":"45","author":[{"given":"Shinjiro","family":"Kobayashi","sequence":"first","affiliation":[{"name":"Division of Gastroenterological and General Surgery St. Marianna University School of Medicine 2\u201016\u20101 Sugao, Miyamae\u2010ku 216\u20108511 Kawasaki Kanagawa Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Takehito","family":"Otsubo","sequence":"additional","affiliation":[{"name":"Division of Gastroenterological and General Surgery St. Marianna University School of Medicine 2\u201016\u20101 Sugao, Miyamae\u2010ku 216\u20108511 Kawasaki Kanagawa Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hiroshi","family":"Nakano","sequence":"additional","affiliation":[{"name":"Division of Gastroenterological and General Surgery St. Marianna University School of Medicine 2\u201016\u20101 Sugao, Miyamae\u2010ku 216\u20108511 Kawasaki Kanagawa 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October 2020","order":1,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"10 November 2020","order":2,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Compliance with ethical standards"}},{"value":"The authors declare that they have no conflict of interest.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"The institutional review board of St. Marianna University School of Medicine approved this study prior to commencement of data collection and analysis (IRB no. 4288) and waived the informed consent requirement.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Informed consent"}}]}}