title: Implications of arterial anatomy in patients with cancer of the periampullary region.
abstract: OBJECTIVE
  Preoperative information on arterial anatomy in the peripancreatic and hepatic areas is valuable to any surgeon performing pancreatoduodenectomy.
  
  
  METHODS
  Between 1994 and 1998, 49 patients with periampullary cancer (31 distal bile duct and 18 ampullary tumors) underwent visceral angiography and radical pancreatoduodenectomy with lymphadenectomy. Surgically "significant" arterial variations and their effects on operative management and results were examined retrospectively.
  
  
  RESULTS
  Arterial variations were found in 18 patients (37%); 15 (31%) were "significant" and 3 (6%) were "nonsignificant." All 15 patients with "significant" variants required specific type of various preservations of the hepatic arterial system. Intraoperative blood loss, transfused blood units, and operation time were greater in patients with "significant" variations than in patients without (P<0.05). Histopathologic diagnosis, tumor staging, morbidity, and mortality did not differ between the 2 groups. The 5-year survival was 33% for patients with "significant" variations and 63% for patients without (P<0.05).
  
  
  CONCLUSIONS
  Information on arterial anatomy in the peripancreatic and hepatic areas is necessary for preoperative evaluation in patients requiring radical pancreatoduodenectomy. Presence of "significant" arterial variations may be considered as one of the negative prognostic factors in patients with periampullary cancer.
authors.affiliation: Department of Surgery, Nakatsu Municipal Hospital, Nakatsu, Oita, Japan. yoshida-t@nakatsu-hosp.jp
authors.forename: Takanori
authors.initials: T
authors.lastname: Yoshida
authors.forename: Toshifumi
authors.initials: T
authors.lastname: Matsumoto
authors.forename: Yuji
authors.initials: Y
authors.lastname: Morii
authors.forename: Masanori
authors.initials: M
authors.lastname: Aramaki
authors.forename: Shunro
authors.initials: S
authors.lastname: Matsumoto
authors.forename: Hiromu
authors.initials: H
authors.lastname: Mori
authors.forename: Seigo
authors.initials: S
authors.lastname: Kitano
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014670:Ampulla of Vater / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D002445:Celiac Artery / Q000000981:diagnostic imaging*; D003138:Common Bile Duct Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D005260:Female; D006499:Hepatic Artery / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016577:Pancreaticoduodenectomy; D011859:Radiography; D012189:Retrospective Studies; D016896:Treatment Outcome; D014781:Viscera / Q000098:blood supply / Q000000981:diagnostic imaging