Variant hepatic arterial anatomy encountered during pancreatoduodenectomy does not influence postoperative outcomes or resection margin status: A matched pair analysis of 105 patients

Abstract

Background/Aim Anatomic vascular abnormalities of the hepatic arteries are frequent. The aim of the study was to analyze the influence of hepatic arterial variations on postoperative morbidity and resection margin status after pancreatoduodenectomy (PD). Materials/Methods Patients who underwent PD over a 7‐year period (2010‐2017) were included in the study. Patients with variant hepatic arterial anatomy were matched 1:2 for age, sex, ASA score, and histology. Results A total of 232 patients underwent PD. Variant hepatic arterial anatomy was found in 35 (15.1% of the total patient population). The most common variation was an accessory right hepatic artery (8.19%) and a replaced right hepatic artery (5.60%) arising from the superior mesenteric artery. These 35 patients were compared with 70 patients with no hepatic artery variations. Postoperative surgical complications occurred in 12.1% and 26.5% (P = 0.08) and in‐hospital mortality was 6% and 5.4% ( P = 0.99) between patients with and without variant hepatic arteries. There was no difference in positive resection margins (R1) (18.2% vs 20.5%, P = 0.99) between the two groups. Conclusions An aberrant hepatic artery does not increase morbidity or R1 resection in patients undergoing PD.

Precision anatomy for safe approach to pancreatoduodenectomy for both open and minimally invasive procedure: A systematic review

“…There are several terms that describe the variation of hepatic arteries: "aberrant," "accessory," "replacement," "substitute," and "anomalous." [11][12][13][14][15][16][17][18] However, the definitions of these terms were different in each report and were not explained or defined in several reports. Crocetti et al 18 described right hepatic artery (RHA) variations to be divided into "accessory" and "aberrant."…”

Cattell‐Braasch maneuver facilitates the artery‐first approach and complete excision of the mesopancreas for pancreatoduodenectomy

“…The Cattell‐Braasch maneuver had other advantages for the resection of pancreatic cancer. A replaced right hepatic artery (RHA) originating from the SMA, an anatomical abnormality, is occasionally observed (5.6%‐18.3%) and increases the difficulty of resection around the hepatoduodenal ligament 19,20 . The Cattell‐Braasch maneuver identifies the bifurcation of the replaced RHA, and facilitates complete resection around the SMA and preservation of the replaced RHA (Figure 5).…”

Cattell‐Braasch maneuver in pancreatic surgery. No need of venous graft for vascular resection

“…16 Moreover, many times the anatomical presentations can present various difficulties like right hepatic artery (RHA) from SMA and different origins of the IPDA which can make the resection more complex, the Cattell-Braasch maneuver allows identifying RHA and IPDA anomalies. [17][18][19] Finally, the possibility of venous resection and reconstruction without graft interposition gives broader access to care in a challenging environment also where resources are limited. The Cattell-Braasch manoeuver allows a direct venous anastomosis independently of the length of the venous resection.…”

“…Another advantage is represented by an easier assessment of a possible neoplastic SMA involvement in the beginning of the operation and the resulting decrease of unnecessary resections 16 . Moreover, many times the anatomical presentations can present various difficulties like right hepatic artery (RHA) from SMA and different origins of the IPDA which can make the resection more complex, the Cattell‐Braasch maneuver allows identifying RHA and IPDA anomalies 17‐19 . Finally, the possibility of venous resection and reconstruction without graft interposition gives broader access to care in a challenging environment also where resources are limited.…”