title: Influence of aberrant right hepatic artery on perioperative course and longterm survival after pancreatoduodenectomy.
abstract: OBJECTIVE
  An aberrant right hepatic artery (aRHA) is the most frequently encountered vascular anomaly during pancreatoduodenectomy (PD). This study was performed to investigate the incidence of aRHA in a large series of PDs and to explore its relationship with complications and survival.
  
  
  METHODS
  In a consecutive series of 790 PDs, aRHA could be identified or ruled out in 758 patients by reviewing operation reports. Patients with and without aRHA were compared. Main outcome measures were complications and survival (only in patients with a malignancy).
  
  
  RESULTS
  The aRHA group consisted of 143 patients (19%). Characteristics of patients in the aRHA and normal RHA groups were comparable. There were no differences in surgical complications. The aRHA was preserved without damage in 130 patients (91%). Two patients in whom the aRHA was either sacrificed or damaged suffered complications (haemorrhage and intra-abdominal abscess in the right upper quadrant) that may have been related. Longterm survival in patients with a malignancy and an aRHA was not compromised.
  
  
  CONCLUSIONS
  An aRHA is frequently encountered during PD. Preservation is generally feasible without compromising survival in patients with malignant tumours. Surgical morbidity is not higher in patients with an aRHA. Preservation is technically possible in most patients and does not negatively impact on outcomes.
authors.affiliation: Department of Surgery, Academic Medical Centre, Amsterdam, the Netherlands.
authors.forename: Wietse J
authors.initials: WJ
authors.lastname: Eshuis
authors.forename: Klaartje M
authors.initials: KM
authors.lastname: Olde Loohuis
authors.forename: Olivier R C
authors.initials: OR
authors.lastname: Busch
authors.forename: Thomas M
authors.initials: TM
authors.lastname: van Gulik
authors.forename: Dirk J
authors.initials: DJ
authors.lastname: Gouma
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality* / Q000601:surgery*; D000368:Aged; D014670:Ampulla of Vater / Q000601:surgery; D015897:Comorbidity; D005260:Female; D006499:Hepatic Artery / Q000002:abnormalities / Q000000981:diagnostic imaging / Q000601:surgery; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000401:mortality* / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000401:mortality*; D011183:Postoperative Complications / Q000401:mortality / Q000473:pathology; D014057:Tomography, X-Ray Computed