Assessment of hepatic arterial anatomy in keeping with preservation of the vasculature while performing pancreatoduodenectomy: an opinion.
BACKGROUND
Pancreatic surgeons often must make decisions regarding hepatic artery (HA) resection while performing a pancreatoduodenectomy (PD). The purpose of this report was to review and summarize HA resection experience with a focus on vascular preservation during PD and to develop a useful guideline for pancreatic surgeons in dealing with these needs.


METHODS
We reviewed 1324 cases that had available computed tomographic and angiographic findings and summarized the problematic HA variations encountered in PD. In reviewing our PD series (n = 254), we have created a set of guidelines that enable a pragmatic approach to the unique variations in HA and the risks of cancer invasion.


RESULTS
Challenging HA variations during PD were found in 20.1% of the cases and included the common HA arising from the superior mesenteric artery (SMA) (2.34%), a replaced right HA (RHA) from the SMA (9.82%), an RHA or left HA from the gastroduodenal artery (0.97%), and the right anterior or right posterior HA from the SMA (1.06%), among others. In our PD series, the problematic HAs (15.8%) were preserved, except for a single case (0.4%) in which PD involved en bloc resection of the RHA from the SMA due to a cancerous invasion and without right hemihepatectomy.


CONCLUSIONS
Surgeons should have knowledge of the anatomically variable vasculature of the HA when planning for PD. Preoperative imaging studies can aid and should be performed in anticipation of the potential HA variations during PD.
Yang
Sung Hoon
SH
Department of Surgery, Seoul National University College of Medicine, Seoul National University Hospital, Chongno-Gu, Seoul, Korea. moljin@korea.com
Yin
Yong Hu
YH
Jang
Jin-Young
JY
Lee
Seung Eun
SE
Chung
Jin Wook
JW
Suh
Kyung-Suk
KS
Lee
Kuhn Uk
KU
Kim
Sun-Whe
SW
D000465:Algorithms; D000792:Angiography; D006499:Hepatic Artery / Q000033:anatomy & histology* / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D016577:Pancreaticoduodenectomy / Q000379:methods* / Q000592:standards; D011300:Preoperative Care; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed