ObjectiveTo evaluate the application of artery first approach in pancreaticodudenectomy, aiming to explore superior mesenteric artery(SMA) and celiac axis in early stage of operation, confirming the resectability and achieving radical resection of the nervous and lymphatic tissues around axis of celiac artery and SMA. MethodsThe data of 27 patients with suspected carcinoma in pancreatic head who received the artery first approach in pancreaticodudenectomy from Sep, 2009 to Dec, 2013 in our hospital were retrospectively analyized. ResultsEight cases received palliative drainage operation, while other 19 cases received radical pancreatectomy, including 2 cases total pancreatectomy and 17 cases pancreaticodudenectomy, with 5 cases portal vein or superior mesenteric vein resection and reconstruction, 1 case common hepatic artery resection, and 2 cases extended right pancreatectomy. The operative time was(281.28±78.53) min(133-354 min), and amount of bleeding was(352±537) mL(189-1 352 mL). There were no operative death, and no reoperation due to complications. ConclusionArtery first approach is preferred for patients with borderline resectable tumors, pancreatic surgeon should be familiar to the various approach.