title: A replaced right hepatic artery adjacent to pancreatic carcinoma should be divided to obtain R0 resection in pancreaticoduodenectomy.
abstract: BACKGROUND
  The aim of the present study was to clarify the optimal surgical strategy in the patients with right hepatic artery (RHA) variation undergoing pancreaticoduodenectomy (PD) based on the tumor position and the R1 resection rate.
  
  
  METHODS
  A total of 180 consecutive patients who underwent PD for pancreatic ductal adenocarcinoma between January 2000 and May 2013 were evaluated for RHA variation, surgical outcome, and the R1 resection rate retrospectively. In this study, we defined three types of tumors: (i) the resectable type, where tumors were situated more than 10 mm away from the root of the replaced right hepatic artery (rRHA)/replaced common hepatic artery (rCHA); (ii) the adjacent type, where tumors were situated within 10 mm from the root of the rRHA/rCHA without tumor abutment of the superior mesenteric artery (SMA); and (iii) the borderline resectable type, where the tumor abuts the SMA, but does not to exceed 180° of the circumference of the vessel wall.
  
  
  RESULTS
  Twenty-five patients were identified to have a RHA variation in preoperative imaging studies. There were 16 patients with resectable type tumors, five with adjacent type tumors, and four with borderline resectable tumors. The rRHA/rCHA was preserved in 14 (88 %) patients with the resectable type, all of the patients with the adjacent type and none of the patients with the borderline type pancreatic carcinomas. The R1 resection rates were significantly higher in patients with adjacent/borderline resectable type tumors (78 %) compared to those with resectable type tumors (6 %) (p = 0.001).
  
  
  CONCLUSIONS
  The rRHA of the adjacent type pancreatic carcinoma should be divided to improve the rate of R0 resection.
authors.affiliation: Second Department of Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8510, Japan, okada@wakayama-med.ac.jp.
authors.forename: Ken-Ichi
authors.initials: K
authors.lastname: Okada
authors.forename: Manabu
authors.initials: M
authors.lastname: Kawai
authors.forename: Seiko
authors.initials: S
authors.lastname: Hirono
authors.forename: Motoki
authors.initials: M
authors.lastname: Miyazawa
authors.forename: Atsushi
authors.initials: A
authors.lastname: Shimizu
authors.forename: Yuji
authors.initials: Y
authors.lastname: Kitahata
authors.forename: Masaji
authors.initials: M
authors.lastname: Tani
authors.forename: Hiroki
authors.initials: H
authors.lastname: Yamaue
mesh_terms: D000230:Adenocarcinoma / Q000601:surgery*; D000368:Aged; D021441:Carcinoma, Pancreatic Ductal / Q000601:surgery*; D006499:Hepatic Artery / Q000002:abnormalities* / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000009:adverse effects / Q000379:methods*; D011183:Postoperative Complications / Q000453:epidemiology