Abstract
Background
The influence and risk associated with an aberrant right hepatic artery, a common
anatomical variation, during pancreatoduodenectomy for pancreatic ductal adenocarcinoma
has not been fully investigated. The present study analyzed the impact of an aberrant
right hepatic artery on local recurrence after pancreatoduodenectomy for pancreatic
ductal adenocarcinoma.
Methods
A total of 169 patients with pancreatic ductal adenocarcinoma who underwent pancreatoduodenectomy
at 2 separate Japanese medical institutions were retrospectively analyzed.
Results
Thirty of 169 patients (17.7%) presented with an aberrant right hepatic artery. The
incidence of local recurrence was higher in the aberrant right hepatic artery group
than in the normal right hepatic artery group (43.3 vs 21.5%, P = .017). The local recurrence-free survival was significantly poorer in the aberrant
right hepatic artery group than in the normal right hepatic artery group (P = .011). A multivariate analysis found that the aberrant right hepatic artery was
an independent risk factor for local recurrence (hazard ratio: 3.74, P = .017). In the aberrant right hepatic artery group, more frequent local recurrence
was observed in patients with tumors situated ≤10 mm from the aberrant right hepatic
artery root. However, local recurrence was not observed in 2 out of 3 patients with
tumors ≤10 mm from the aberrant right hepatic artery root who underwent pancreatoduodenectomy
with combined resection of the aberrant right hepatic artery.
Conclusion
The presence of an aberrant right hepatic artery in patients undergoing pancreatoduodenectomy
for pancreatic ductal adenocarcinoma may be associated with an increased risk of postoperative
local recurrence. Combined resection of the aberrant right hepatic artery may reduce
local recurrence, especially for tumors near the root of the aberrant right hepatic
artery.
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References
- Projecting cancer incidence and deaths to 2030: the unexpected burden of thyroid, liver, and pancreas cancers in the United States.Cancer Res. 2014; 74: 2913-2921
- Pancreatic cancer.Lancet. 2011; 378: 607-620
- Adjuvant chemotherapy of S-1 versus gemcitabine for resected pancreatic cancer: a phase 3, open-label, randomized, non-inferiority trial (JASPAC 01).Lancet. 2016; 388: 248-257
- Comparison of adjuvant gemcitabine and capecitabine with gemcitabine monotherapy in patients with resected pancreatic cancer (ESPAC-4): a multicentre, open-label, randomized, phase 3 trial.Lancet. 2017; 389: 1011-1024
- Patterns, timing, and predictors of recurrence following pancreatectomy for pancreatic ductal adenocarcinoma.Ann Surg. 2018; 267: 936-945
- Recurrence after resection for ductal adenocarcinoma of the pancreas.World J Surg. 1997; 21: 195-200
- Comparison of the long-term outcomes of uncinate process cancer and non-uncinate process pancreas head cancer: poor prognosis accompanied by early locoregional recurrence.Langenbecks Arch Surg. 2010; 395: 697-706
- Patterns of local recurrence after curative resection in pancreatic ductal adenocarcinoma according to the initial location of the tumor.J Hepatobiliary Pancreat Sci. 2021; 28: 105-114
- Surgical anatomy of the hepatic arteries in 1000 cases.Ann Surg. 1994; 220: 50-52
- Newer anatomy of the liver and its variant blood supply and collateral circulation.Am J Surg. 1996; 112: 337-347
- Pancreatic cancer.Lancet. 2016; 388: 73-85
- Clinical implications of an aberrant right hepatic artery in patients undergoing pancreaticoduodenectomy.World J Surg. 2009; 33: 1727-1732
- Aberrant right hepatic artery with a prepancreatic course visualized prior to pancreaticoduodenectomy.J Gastrointest Surg. 2013; 17: 1024-1026
- Implications of the presence of an aberrant right hepatic artery in patients undergoing pancreaticoduodenectomy.World J Gastrointest Surg. 2014; 6: 9-13
- A replaced right hepatic artery adjacent to pancreatic carcinoma should be divided to obtain R0 resection in pancreaticoduodenectomy.Langenbecks Arch Surg. 2015; 400: 57-65
- Pancreatic adenocarcinoma, version 2.2017, NCCN clinical practice guidelines in oncology.J Natl Compr Canc Netw. 2017; 15: 1028-1061
- Portal vein resection.Surg Clin North Am. 2010; 90: 309-322
- Critical steps for pancreaticoduodenectomy in the setting of pancreatic adenocarcinoma.J Surg Oncol. 2013; 107: 33-38
- Classification of R1 resections for pancreatic cancer: the prognostic relevance of tumour involvement within 1 mm of a resection margin.Histopathol. 2009; 55: 277-283
- Utility of tumor markers in determining resectability of pancreatic cancer.Arch Surg. 2003; 138: 951-955
- Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey.Ann Surg. 2004; 240: 205-213
- Patterns of recurrence after curative resection of pancreatic cancer, based on autopsy findings.J Gastrointest Surg. 2006; 10: 511-518
- Survival after pancreaticoduodenectomy is not improved by extending resections to achieve negative margins.Ann Surg. 2009; 250: 76-80
- Radiographic patterns of first disease recurrence after neoadjuvant therapy and surgery for patients with resectable and borderline resectable pancreatic cancer.Surgery. 2020; 168: 440-447
- Neoadjuvant therapy affects margins and margins affect all: perioperative and survival outcomes in resected pancreatic adenocarcinoma.HPB (Oxford). 2018; 20: 573-581
- Is a pathological complete response following neoadjuvant chemoradiation associated with prolonged survival in patients with pancreatic cancer?.Ann Surg. 2018; 268: 1-8
- Impact of resection margin status on survival in pancreatic cancer patients after neoadjuvant treatment and pancreatoduodenectomy.Surgery. 2020; 167: 803-811
- Prognostic significance of new AJCC tumor stage in patients with pancreatic ductal adenocarcinoma treated with neoadjuvant therapy.Am J Surg Pathol. 2017; 41: 1097-1104
- The TRIANGLE operation—radical surgery after neoadjuvant treatment for advanced pancreatic cancer: a single arm observational study.HPB (Oxford). 2017; 19: 1001-1007
- Surgical technique and results of total mesopancreas excision (TMpE) in pancreatic tumors.Eur J Surg Oncol. 2012; 38: 340-345
- Perineural invasion by ductal adenocarcinoma of the pancreas.J Surg Oncol. 1997; 65: 164-170
Crippa S, Pergolini I, Javed AA, et al. Implications of perineural invasion on disease recurrence and survival following pancreatectomy for pancreatic head ductal adenocarcinoma. Ann Surg. 2020. https://doi.org/10.1097/SLA.0000000000004464. Accessed December 28, 2021.
- Multicenter randomized phase II trial of prophylactic right-half dissection of superior mesenteric artery nerve plexus in pancreatoduodenectomy for pancreatic head cancer.Ann Gastroenterol Surg. 2020; 5: 111-118
- Management of the right hepatic artery in pancreaticoduodenectomy: a systematic review.J Gastrointest Oncol. 2016; 7: 298-305
- The implications of the presence of an aberrant right hepatic artery in patients undergoing a pancreaticoduodenectomy.Surg Today. 2009; 39: 669-674
- Influence of aberrant right hepatic artery on perioperative course and longterm survival after pancreatoduodenectomy.HPB. 2011; 13: 161-167
- Preservation of replaced or accessory right hepatic artery during pancreaticoduodenectomy for adenocarcinoma: impact on margin status and survival.J Gastrointest Surg. 2010; 14: 1813-1819
- Does an aberrant right hepatic artery really influence the short- and long-term results of a pancreaticoduodenectomy for malignant disease? A matched case-controlled study.J Surg Res. 2013; 185: 620-625
Article info
Publication history
Published online: March 22, 2022
Accepted:
February 15,
2022
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
ScienceDirect
Access this article on ScienceDirectLinked Article
- The importance of vascular anatomy and r1 site in the oncologic outcome of pancreatoduodenectomy for pancreatic cancer: The case of an aberrant right hepatic arterySurgeryVol. 172Issue 2
- PreviewRadical resection of pancreatic ductal adenocarcinoma (PDAC) requires a vessel-oriented approach, because of the close anatomic relationships with retroperitoneal vessels and the high frequency of extrapancreatic nerve plexus (ENP) invasion. Therefore, pancreatic surgeons should be familiar with vascular surgery techniques. This is the vision of a pancreatic surgeon who also performs transplants and received training in vascular surgery. On practical grounds, I never left a macroscopic tumor residual in over 2,000 pancreatic resections.
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