Objective To investigate the clinical effect of the artery-first approach versus the traditional approach for pancreaticoduodenectomy.Methods PubMed,Embase,Cochrane Library,Wanfang Data,CNKI,and VIP were searched for randomized controlled trials(RCTs) and non-RCTs on the artery-first approach versus the traditional approach for pancreaticoduodenectomy published from January1,2003 to January 31,2020,and the articles were screened according to inclusion and exclusion criteria.RevMan5.3 software was used to perform the meta-analysis.Mean difference and odds ratio(OR) were used to analyze continuous variables and binary variables,95%confidence interval(CI) was calculated for each variable.The fixed effects model was used for unobserved heterogeneity,and the random effects model was used for significant heterogeneity.Funnel plots were used to evaluate the absence or presence of publication bias.Results A total of 18 articles were included.The results of the meta-analysis showed that compared with pancreaticoduodenectomy with the traditional approach,pancreaticoduodenectomy with the artery-first approach reduced pancreatic fistula(OR=0.68,95% CI:0.48-0.94,P<0.05),delayed gastric emptying after surgery(OR=0.51,95% CI:0.35-0.73,P<0.05),postoperative abdominal infection(OR=0.50,95% CI:0.30-0.84,P<0.05),local recurrence(OR=0.36,95% CI:0.20-0.65,P<0.05),and incidence rate of blood transfusion(OR=0.20,95% CI:0.07-0.59,P<0.05) and increased R0 resection rate(OR=3.04,95% CI:1.86-4.99,P<0.05).Symmetric funnel plots were observed for the incidence rates of pancreatic fistula and delayed gastric emptying after surgery,suggesting that publication bias of the articles included had little influence on the results of this study.Conclusion The artery-first approach is as safe and feasible as the traditional approach for pancreaticoduodenectomy,and the artery-first approach is superior to the traditional approach in reducing some important postoperative complications and increasing R0 resection rate.Therefore,the artery-first approach holds promise for clinical application. [ABSTRACT FROM AUTHOR]