title: Preservation of replaced or accessory right hepatic artery during pancreaticoduodenectomy for adenocarcinoma: impact on margin status and survival.
abstract: OBJECTIVE
  The aim of the study was to determine the impact of replaced or accessory right hepatic artery (RARHA) during pancreaticoduodenectomy (PD) for pancreatic adenocarcinoma (PA).
  
  
  METHODS
  Four hundred seventy-one consecutive patients underwent PD for PA at the two institutions; 47 patients (10%) had RARHA: 16 patients (neoRARHA group) received neoadjuvant chemoradiation, and 31 patients did not receive preoperative treatment (RARHA group). Thirty-one matched patients without RARHA comprised our control group.
  
  
  RESULTS
  RARHA was preserved in 44 patients; three patients with involved RARHA had reconstruction (n = 2) or ligation (n = 1). Patients with R1 resection (n = 8) had tumor size ≥3 cm. Patients in the neoRARHA group had identical positive margin rate when compared with patients in RARHA group (p = 0.6). No difference was noted in median or 3-year overall survival times between RARHA group and control group. Two patients in RARHA group with involved RARHA died of disease progression after 6 and 12 months of follow-up. One patient in neoRARHA group with involved RARHA was still alive without recurrence after 28 months' follow-up.
  
  
  CONCLUSIONS
  Pathologic findings did not show increased positive margins despite preservation of RARHA. In contrast, patients with frank RARHA involvement seemed to have poor survival. Thus, patients with suspicion of involved RARHA should be considered for neoadjuvant chemoradiation.
authors.affiliation: Department of Surgery, Institut Paoli Calmettes, Marseille, France.
authors.forename: Olivıer
authors.initials: O
authors.lastname: Turrini
authors.forename: Eric A
authors.initials: EA
authors.lastname: Wiebke
authors.forename: Jean Robert
authors.initials: JR
authors.lastname: Delpero
authors.forename: Frédéric
authors.initials: F
authors.lastname: Viret
authors.forename: Keith D
authors.initials: KD
authors.lastname: Lillemoe
authors.forename: C Max
authors.initials: CM
authors.lastname: Schmidt
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D000368:Aged; D005260:Female; D006499:Hepatic Artery / Q000002:abnormalities* / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000379:methods; D015996:Survival Rate