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

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 ICUand 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.

The Presence of an Aberrant Right Hepatic Artery Did Not Influence Surgical and Oncological Outcomes After Pancreaticoduodenectomy: A Comprehensive Systematic Review and Meta‐Analysis

“…Twenty studies [3,[24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42] were eligible for the analysis. papers (65%) used a standardized classification of the a-RHAs.…”

“…This vascular abnormality could influence the oncological and postoperative results. On one side, the attempt to preserve the a-RHA could produce a lesser R0 rate on the superior mesenteric artery (SMA) margin, increasing the risk of local recurrence [ 2 , 3 ]. Indeed, some authors [ 4 ] advocated the ligation or resection and reconstruction of a-RHA during PD [ 5 ].…”

Pancreaticoduodenectomy: how to handle a replaced right hepatic artery

“…Arterial flow cutoff to the a-RHA may be associated with a biliary leak or stenosis at the choledocho-jejunostomy and liver ischemia, resulting in ischemic cholangitis, liver abscess, and sepsis ( 1 ). Pyras and colleagues reported successful preservation of all 80 a-RHAs among 353 consecutive PDs during a 5-year period by paying particular attention to avoid damage to the a-RHA during dissection and division of the common bile duct ( 2 ). Critically, they did not focus on selected a-RHA cases but rather focused on a cohort of consecutive PDs during a long 5-year period.…”

“…Nowadays, the majority of hospitals can acquire multidetector-row computed tomography (CT) images as a “climbing map”, which is also recommended in the National Comprehensive Cancer Network (NCCN) guideline for evaluating pancreatic ductal adenocarcinoma (PDAC) ( 5 ). Pyras and colleagues report that they were able to accurately diagnose a-RHA before surgery using multidetector-row CT as the current standard ( 2 ).…”

Preservation of aberrant right hepatic artery during pancreaticoduodenectomy

“…The study “ Preservation of aberrant right hepatic arteries does not affect safety and oncological radicality of pancreaticoduodenectomy - own results and a systematic review of the literature ” provides valuable insights into the impact of preserving aRHAs during PD ( 15 ).…”