Anomalies of the right hepatic artery in periampullary cancers treatment: are pathological and clinical outcomes different? A single tertiary referral center retrospective analysis

Abstract

Purpose Anomalies of the right hepatic artery (RHA) may represent an additional challenge in pancreatoduodenectomy (PD). Aim of this study is to assess the potential impact of variations in hepatic arterial anatomy on perioperative outcomes. Methods PDs performed for periampullary malignancies between 2017 and 2022 were retrospectively enrolled. Patients were, thus, subdivided according to the pattern of vascularization into: modal pattern of vascularization (MPV) and anomalous pattern of vascularization (APV). A 2:1 propensity-score matching (PSM) analysis was conducted to homogenize the two study populations. The two groups were then compared in terms of peri-operative outcomes and pathological findings. Results Thirty-eight patients (16.3%) out of 232 presented a vascular anomaly: an accessory RHA in 7 cases (3%), a replaced RHA in 26 cases (11.2%) and a replaced HA in 5 cases (2.1%). After PSM, 76 MPV patients were compared to the 38 APV patients. Incidence rate of post-operative complications was comparable between the two study populations (p = 0.2). Similarly, no difference was detected in terms of histopathological data, including margin status. No difference was noted in terms of perioperative hemorrhage (p = 0.6). No patients needed an arterial resection. Conclusion When PDs are performed in high-volume centers, the presence of anomalies of the RHA do not relate to a significant impact on perioperative complications. Moreover, no influence was noted in terms of histopathological findings.