Superior Mesenteric Artery First Versus Standard Approach in Pancreaticoduodenectomy

Inclusion Criteria: 1. Primary resectable or borderline with isolated veinous contact pancreatic adenocarcinoma (according to the NCCN classification and international consensual definition of Isaji 2018): resectability is evaluated on arterial-phase and portal-phase IV contrast-enhanced multislice CT scan of the pancreas (slice thickness: 2.5 mm), and assessed in a multidisciplinary staff meeting including at least one radiologist and one expert surgeon. 2. CT-scan of the thorax and abdomen confirming non-metastatic PAC at least 45 days before inclusion 3. MRI of the liver without metastasis performed maximum one month before inclusion 4. CA 19.9 (carbohydrate antigen) level ≤ 500 U/mL at the time of inclusion (in absence of cholestasis or biliary drainage) 5. Age 18 or over 6. Grade 0 or 1 Performans Status (ECOG) 7. Normal renal and liver function at the time of inclusion (According to Cockroft and Gault's equation Glomerular Function Rate \> 50ml/min/m2; Prothrombin Time \> 70%) 8. Absolute neutrophil count \> 1,500/mm3, platelet count \> 100,000/mm3, haemoglobin level \> 10 g/dl (transfusions are authorized) at time of inclusion 9. Adequate contraception on fertile women 10. "Women of childbearing potential (defined as under 50 years of age and without a history of hysterectomy or tubal ligation) must not self-report being pregnant on the day of inclusion." 11. Patient who provides a signed written informed consent form 12. Patient having the rights to French social insurance Exclusion Criteria: 1. Pancreatic adenocarcinoma defined as "borderline" with arterial contact, locally advanced, non-resectable, or metastatic. 2. Surgical or anesthesiologic contra-indications: Non-controlled congestive heart failure - non-treated angina - recent myocardial infarction (in the previous year) - non-controlled AHT (SBP \>160 mm or DBP \> 100 mm, despite optimal drug treatment), long QT 3. Major non-controlled infection 4. Major comorbidity that may preclude the surgery 5. Severe liver failure 6. Any medical, psychological, or social situation that (in the investigator's opinion) could limit (i) the patient's compliance with the protocol or (ii) the ability to obtain or interpret data 7. Pregnant or breastfeeding women and women of childbearing age not using effective means of contraception 8. Curatorship or guardianship or patient placed under judicial protection 9. Participation in other interventional research type 1, clinical investigation or clinical trial during the study Secondary exclusion criterion (during surgery): 1. Evaluation of abdominal cavity, presenting infra-radiologic metastasis 2. Positive tumoral invasion at frozen section after picking on the inter-aortic lymph nodes performed before any irrevocable organ section. 3. Anasthaesiologic complication (induction allergy or unprevisible heart disease at induction) 4. For fertile women: serological pregnancy test positive before surgery