resections. Although higher, the increase in the overall R0 resection margins (28.6% vs 36.3%, p¼0.375) and the posterior resection margins (42.9% vs 36.3%, p¼0.481) 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

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... 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.