Assessment of hepatic arterial anatomy in keeping with preservation of the vasculature while performing pancreatoduodenectomy: an opinion

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Yang, Sung Hoon; Yin, Yong Hu; Jang, Jin-Young; Lee, Seung Eun; Chung, Jin Wook; Suh, Kyung-Suk; Lee, Kuhn Uk; Kim, Sun-Whe

Issue Date
Springer Verlag
World J Surg. 2007 ;31(12):2384-91.
AlgorithmsAngiographyHepatic Artery/*anatomy & histology/radiography/*surgeryHumansPancreaticoduodenectomy/*methods/standardsPreoperative CareRetrospective StudiesTomography, X-Ray Computed
BACKGROUND: Pancreatic surgeons often must make decisions regarding hepatic artery (HA) resection while performing a pancreatoduodenectomy (PD). The purpose of this report was to review and summarize HA resection experience with a focus on vascular preservation during PD and to develop a useful guideline for pancreatic surgeons in dealing with these needs. METHODS: We reviewed 1324 cases that had available computed tomographic and angiographic findings and summarized the problematic HA variations encountered in PD. In reviewing our PD series (n = 254), we have created a set of guidelines that enable a pragmatic approach to the unique variations in HA and the risks of cancer invasion. RESULTS: Challenging HA variations during PD were found in 20.1% of the cases and included the common HA arising from the superior mesenteric artery (SMA) (2.34%), a replaced right HA (RHA) from the SMA (9.82%), an RHA or left HA from the gastroduodenal artery (0.97%), and the right anterior or right posterior HA from the SMA (1.06%), among others. In our PD series, the problematic HAs (15.8%) were preserved, except for a single case (0.4%) in which PD involved en bloc resection of the RHA from the SMA due to a cancerous invasion and without right hemihepatectomy. CONCLUSIONS: Surgeons should have knowledge of the anatomically variable vasculature of the HA when planning for PD. Preoperative imaging studies can aid and should be performed in anticipation of the potential HA variations during PD.
0364-2313 (Print)
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College of Medicine/School of Medicine (의과대학/대학원)Surgery (외과학전공)Journal Papers (저널논문_외과학전공)
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