title: Hepatic artery reconstruction following ablative surgery for hepatobiliary and pancreatic malignancies.
abstract: OBJECTIVE
  Hepatic artery (HA) reconstruction is an important part of resective surgery for advanced hepatobiliary and pancreatic malignancies, but few reports have been published. To identify indications for HA reconstruction, we retrospectively analyzed our surgical procedures and outcomes.
  
  
  METHODS
  En-bloc resection of advanced hepatobiliary and pancreatic malignancies followed by HA reconstruction was performed in 35 patients. Patients ranged in age from 27 to 81 years and included 18 men and 17 women. The primary site of cancer included the bile duct in 22 patients, the pancreas in 7, and others in 6. Reconstruction of the HA was necessitated by HA resection due to direct cancer invasion in 29 patients and by accidental arterial injury during surgical procedure in 6 patients.
  
  
  RESULTS
  The HA was reconstructed with end-to-end anastomosis between hepatic arteries in 17 patients. Transposition of an intra-abdominal artery, such as the gastroepiploic artery, was required in 14 patients, and arterial grafting was required in 4 patients. Although the HA patency was achieved in 30 patients, 4 cases of arterial thrombosis and 1 case of arterial rupture developed postoperatively. The overall RFS time was analyzed in all patients, and mean and median RFS times were 18 and 9 months, respectively.
  
  
  CONCLUSIONS
  Although oncologic outcomes remain poor, HA resection and reconstruction can be performed in selected patients. We believe that the method of first choice for HA reconstruction is end-to-end anastomosis between HAs. A vascular autograft should be used only in selected cases.
authors.affiliation: Division of Plastic and Reconstructive Surgery, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa-shi, 277-8577 Chiba, Japan. msakurab@east.ncc.go.jp
authors.forename: M
authors.initials: M
authors.lastname: Sakuraba
authors.forename: S
authors.initials: S
authors.lastname: Miyamoto
authors.forename: S
authors.initials: S
authors.lastname: Nagamatsu
authors.forename: S
authors.initials: S
authors.lastname: Kayano
authors.forename: M
authors.initials: M
authors.lastname: Taji
authors.forename: T
authors.initials: T
authors.lastname: Kinoshita
authors.forename: T
authors.initials: T
authors.lastname: Kosuge
authors.forename: Y
authors.initials: Y
authors.lastname: Kimata
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical; D001661:Biliary Tract Neoplasms / Q000601:surgery*; D001662:Biliary Tract Surgical Procedures / Q000009:adverse effects*; D018572:Disease-Free Survival; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects*; D006499:Hepatic Artery / Q000293:injuries* / Q000601:surgery*; D006801:Humans; D008113:Liver Neoplasms / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010180:Pancreatectomy / Q000009:adverse effects*; D010190:Pancreatic Neoplasms / Q000601:surgery*; D019651:Plastic Surgery Procedures / Q000379:methods; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000379:methods*