title: Management of the right hepatic artery in pancreaticoduodenectomy: a systematic review.
abstract: BACKGROUND
  The right hepatic artery (RHA) is the most common hepatic artery (CHA) variation. This variation may be problematic in pancreaticoduodenectomy (PD). We aimed to evaluate the impact of the RHA on postoperative and oncological outcomes.
  
  
  METHODS
  The PubMed database was systematically searched for comparative studies reporting management of the RHA during PD for the years 1950-2014.
  
  
  RESULTS
  A total of 2,278 patients were analyzed, of whom 440 (19%) had a RHA. The most CHA variation was a replaced RHA. The conservative approach was the most frequently adopted (87%) and only 8% of patients had a sacrifice without reconstruction of the RHA. Postoperative mortality and overall morbidity were similar between patients with and without RHA. Despite the preservation of the RHA in most cases, the rates of microscopic positive margin were also comparable between two groups with no impact of RHA on survival rates.
  
  
  CONCLUSIONS
  Postoperative and oncological outcomes seemed unaffected by the RHA in PD. Prospective studies are needed to evaluate its oncological impact.
authors.affiliation: Department of Digestive Surgery and Transplantation, CHRU de Lille, Lille, France.
authors.forename: Mehdi
authors.initials: M
authors.lastname: El Amrani
authors.affiliation: Department of Digestive Surgery and Transplantation, CHRU de Lille, Lille, France.
authors.forename: François-René
authors.initials: FR
authors.lastname: Pruvot
authors.affiliation: Department of Digestive Surgery and Transplantation, CHRU de Lille, Lille, France.
authors.forename: Stéphanie
authors.initials: S
authors.lastname: Truant
keywords: Pancreatoduodenectomy (PD); aberrant artery; hepatic artery variation; right hepatic artery (RHA)