Introduction With increased numbers of borderline locally advanced patients undergoing resection due to the acceptance of portal vein (PV) resection, early dissection of the superior mesenteric artery (SMA) allows definitive assessment of the tumour/SMA relationship and improved control when PV resection is required.

Methods The lymph node yield, resection margins, morbidity and mortality data were compared between patients undergoing Artery first technique of pancreaticoduodenectomy (January 2009–December 2010) and previous resections (January 2000–December 2008).

Results 42 resections were carried out using the artery first technique were age, sex and pathology matched with 182 previous resections. Although higher, the increase in the overall R0 resection margins (28.6% vs 36.3%, p=0.375) and the posterior resection margins (42.9% vs 36.3%, p=0.481) didn't meet significance. The mean lymph node yield was significantly increased (19 vs 27, p<0.05) but there was no significant difference in the post-operative morbidity and mortality rates between the two groups. The actuarial 1 and 2 year survival was 72% and 49.4% for earlier resections and 71.8% and 56.8% for Artery first PPPD respectively. The 1 and 2 year disease free survival was 65.2% and 47% for earlier resections and 67.6% and 64.4% for Artery first PPPD.

Conclusion Artery first resection enhances the clearance at the SMA (a common site for R1 resection) with increased lymph node yield. The 2-year follow-up with Artery first PPPD shows a trend towards improving overall and disease free survival.

Competing interests None declared.