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. 2022 Feb;11(1):25-37.
doi: 10.21037/hbsn-20-352.

Preservation of aberrant right hepatic arteries does not affect safety and oncological radicality of pancreaticoduodenectomy-own results and a systematic review of the literature

Cedrik Pyras  1 , Carsten Lukas  2 , Monika Janot-Matuschek  1 , Torsten Herzog  1 , Andrea Tannapfel  3 , Waldemar Uhl  1 , Orlin Belyaev  1
Affiliations

Preservation of aberrant right hepatic arteries does not affect safety and oncological radicality of pancreaticoduodenectomy-own results and a systematic review of the literature

Cedrik Pyras et al. Hepatobiliary Surg Nutr. 2022 Feb.

Abstract

Background: Aberrant right hepatic arteries (aRHA) are frequently encountered during pancreaticoduodenectomy (PD). Their effects on surgical morbidity and resection margin are still debated. This study aimed to compare the short term and long term outcomes in patients with and without aRHA.

Methods: A single-center retrospective analysis of 353 consecutive PD during a 5-year period was done. The type of arterial supply was determined preoperatively by CT and confirmed at surgery. Hiatt types III-VI included some type of aRHA and comprised the study group. Hiatt types I and II were considered irrelevant for PD and used as controls. Primary endpoints were the rates of major postoperative complications and the rate of R0-resection in cases of malignant disease. Secondary endpoints included duration of surgery, postoperative stay, number of harvested lymph nodes and survival in patients with pancreatic cancer. Own results were compared to existent data using a systematic review of the literature.

Results: No aRHA had to be sacrificed or reconstructed. Surgical morbidity and specific complications such as post-pancreatectomy hemorrhage (PPH), pancreatic fistula and bile leak were the same in patients with and without aRHA. There was no significant difference in operative time, blood loss, length of ICU- and hospital stay. Patients with malignancy had similar high rates of R0-resection and identical number of harvested lymph nodes. Survival of patients with pancreatic cancer was not affected by aRHA.

Conclusions: aRHA may be preserved in virtually all cases of PD for resectable pancreatic head lesions without increasing surgical morbidity and without compromising oncological radicality in patients with cancer, provided the variant anatomy is being recognised on preoperative CT and a meticulous surgical technique is used.

Keywords: Replaced hepatic artery; accessory hepatic artery; complications; pancreatic cancer; pancreatic surgery; resection margin; vascular anomalies.

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Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://hbsn.amegroups.com/article/view/10.21037/hbsn-20-352/coif). The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
3D-reconstruction of visceral arteries based on the arterial phase of CT showing common hepatomesenteric trunk (Hiatt type V). The arrow points at the root of CHA originating from SMA. SMA, superior mesenteric artery; CHA, common hepatic artery; RHA, right hepatic artery; LHA, left hepatic artery; SA, splenic artery; GDA, gastroduodenal artery.
Figure 2
Figure 2
Intraoperative view of PD after completed resection, arrows showing the aRHA from SMA coming from beneath the PV and then dorsolateral to the CBD. CBD, common bile duct; PV, portal vein; SMA, superior mesenteric artery.
Figure 3
Figure 3
PRISMA flow diagram of the study.
Figure 4
Figure 4
Kaplan-Meier survival curves for patients with PDAC. RHA, right hepatic artery; PDAC, pancreatic ductal adenocarcinoma.
See this image and copyright information in PMC

Comment in

References

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