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Superior Mesenteric Artery First Versus Standard Approach in Pancreaticoduodenectomy
Sponsor: Assistance Publique - Hôpitaux de Paris
Summary
"Pancreatic cancer, especially pancreatic ductal adenocarcinoma, is one of the most serious and deadly cancers. Its outlook is very poor, with fewer than 10% of patients surviving five years after diagnosis. This is largely because the disease is often discovered at a late stage and because it frequently comes back even after surgery. When the tumor is located in the head of the pancreas, the only treatment that can potentially cure the disease is a major operation called a pancreaticoduodenectomy, also known as the Whipple procedure. This surgery is now safely performed in specialized hospitals, but it remains complex and carries a high risk of complications. Importantly, even after surgery, cancer cells often remain, leading to a high rate of local recurrence. A newer surgical technique, known as the "artery-first" approach, changes the order of the operation. By carefully exposing a major blood vessel near the pancreas at the beginning of the surgery, surgeons can better assess whether the tumor can be completely removed and can improve the precision of the operation. This research protocol aims to compare this artery-first technique with the standard surgical approach. The goal is to determine whether starting the operation by addressing the artery allows for more complete tumor removal and reduces the risk of cancer coming back in patients with pancreatic cancer of the head of the pancreas."
Key Details
Gender
All
Age Range
18 Years - Any
Study Type
INTERVENTIONAL
Enrollment
150
Start Date
2026-09-01
Completion Date
2031-09-01
Last Updated
2026-04-23
Healthy Volunteers
No
Interventions
SMA-first pancreaticoduodenectomy using either right posterior or anterior approach. SMA identified and isolated with peri-adventitial dissection before any irreversible section.
Before any irreversible gesture, the surgeon identifies and isolates the superior mesenteric artery and dissects nerve plexus and nodes on the right side up to the SMA origin (right posterior or anterior approach).
Conventional pancreaticoduodenectomy without prior isolation of the SMA; antero-posterior approach of the uncinate process after pancreatic section.
Conventional pancreaticoduodenectomy without prior isolation of the SMA; antero-posterior approach of the uncinate process after pancreatic section.
Locations (23)
CHU Amiens
Amiens, France
CHU Angers
Angers, France
CHU Besançon
Besançon, France
Hôpital Haut Lévêque
Bordeaux, France
Hôpital Estaing
Clermont-Ferrand, France
Hôpital François Mitterrand
Dijon, France
CHU Lille - Hôpital Claude Huriez
Lille, France
Hôpital Claude Huriez
Lille, France
CHU Dupuytren 1
Limoges, France
Centre Léon Bérard
Lyon, France
Hôpital de la Croix-Rousse
Lyon, France
Hôpital Saint Eloi
Montpellier, France
Hôpitaux de Brabois
Nancy, France
Chu Nantes
Nantes, France
Hôpital Ambroise Paré
Paris, France
Hôpital Beaujon
Paris, France
Hôpital Cochin
Paris, France
Hôpital de la Pitié Salpêtrière
Paris, France
Hôpital Charles-Nicolle
Rouen, France
CHU Strasbourg
Strasbourg, France
Hôpital Rangueil
Toulouse, France
Hôpital Paul Brousse
Villejuif, France
Institut Gustave Roussy
Villejuif, France