title: Implication of the presence of a variant hepatic artery during the Whipple procedure.
abstract: BACKGROUND
  The anatomical variants of the hepatic artery may have important implications for pancreatic cancer surgery. The aim of our study is to compare the outcome following a pancreatoduodenectomy (PD) in patients with or without a variant hepatic artery arising from superior mesenteric artery.
  
  
  METHODS
  We reviewed 151 patients with periampullary tumoral pathology. All patients underwent oncological PD between January 2005 and February 2012. Our series was divided into two groups: Group A: Patients with a hepatic artery arising from superior mesenteric artery; and Group B: Patients without a hepatic artery arising from superior mesenteric artery. We expressed the results as mean +/- standard deviation for continuous variables and percentages for qualitative variables. Statistical tests were considered significant if p < 0.05.
  
  
  RESULTS
  We identified 11 patients with a hepatic artery arising from superior mesenteric artery (7.3%). The most frequent variant was an aberrant right hepatic artery (n = 7), following by the accessory right hepatic artery (n = 2) and the common hepatic artery trunk arising from the superior mesenteric artery (n = 2). In 73% of cases the diagnosis of the variant was intraoperative. R0 resection was performed in all patients with a hepatic artery arising from superior mesenteric artery. There were no significant differences in the tumor resection margins and the incidence of postoperative complications.
  
  
  CONCLUSIONS
  Oncological PD is feasible by the presence of a hepatic artery arising from superior mesenteric artery. The complexity of having it does not seem to influence in tumor resection margins, complications and survival.
authors.forename: Mercedes
authors.initials: M
authors.lastname: Rubio-Manzanares-Dorado
authors.forename: Luis Miguel
authors.initials: LM
authors.lastname: Marín-Gómez
authors.forename: Daniel
authors.initials: D
authors.lastname: Aparicio-Sánchez
authors.forename: Gonzalo
authors.initials: G
authors.lastname: Suárez-Artacho
authors.forename: Carmen
authors.initials: C
authors.lastname: Bellido
authors.forename: José María
authors.initials: JM
authors.lastname: Álamo
authors.forename: Juan
authors.initials: J
authors.lastname: Serrano-Díaz-Canedo
authors.forename: Francisco Javier
authors.initials: FJ
authors.lastname: Padillo-Ruiz
authors.forename: Miguel Ángel
authors.initials: MÁ
authors.lastname: Gómez-Bravo
mesh_terms: D000230:Adenocarcinoma / Q000150:complications / Q000601:surgery; D000328:Adult; D000368:Aged; D001650:Bile Duct Neoplasms / Q000150:complications / Q000601:surgery; D018281:Cholangiocarcinoma / Q000150:complications / Q000601:surgery; D005260:Female; D006499:Hepatic Artery / Q000002:abnormalities*; D006801:Humans; D008297:Male; D017538:Mesenteric Artery, Superior / Q000002:abnormalities*; D008875:Middle Aged; D018358:Neuroendocrine Tumors / Q000150:complications / Q000601:surgery; D010180:Pancreatectomy; D010190:Pancreatic Neoplasms / Q000150:complications / Q000601:surgery*; D016577:Pancreaticoduodenectomy; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D012189:Retrospective Studies; D016896:Treatment Outcome; D054079:Vascular Malformations / Q000150:complications*