Skip to main content

Advertisement

SpringerLink
Log in

Outcome of concomitant resection of the replaced right hepatic artery in pancreaticoduodenectomy without reconstruction

  • ORIGINAL ARTICLE
  • Published:
Langenbeck's Archives of Surgery Aims and scope Submit manuscript

Abstract

Purpose

It has been reported that preoperative embolization or intraoperative reconstruction of the replaced right hepatic artery (rRHA) in order to secure the arterial blood flow to the liver and biliary tract are useful for patients who have undergone pancreaticoduodenectomy (PD) with concomitant rRHA resection. In this study, the feasibility of concomitant resection of rRHA in PD without preoperative embolization or intraoperative reconstruction were retrospectively evaluated with a particular focus on postoperative complications.

Methods

We retrospectively analyzed 323 consecutive patients who underwent PD.

Results

In 51 patients (15.8%), an rRHA was detected. Nine of 51 patients underwent combined rRHA resection during PD. Eight patients showed tumor abutment, and one patient had accidental intraoperative damage of the rRHA. Although there were no cases of bilioenteric anastomotic failure, a hepatic abscess occurred in one patient. This patient was treated with percutaneous transhepatic abscess drainage and was cured immediately without suffering sepsis. Postoperative complications of Clavien-Dindo classification ≥ IIIa were found in three patients, and R0 resection was achieved in six. Surgical outcomes showed no significant differences between the rRHA-resected and non-resected groups. Moreover, there were no significant differences in laboratory data related to liver functions between the rRHA-resected and non-resected groups before surgery and on postoperative days 1, 3, 5, and 7.

Conclusions

Simple resection of the rRHA following an unintended or accidental injury during PD is not associated with severe morbidity and should be considered as an alternative to a technically difficult reconstruction.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Michels NA (1996) Newer anatomy of the liver and its variant blood supply and collateral circulation. Am J Surg 112:337–347

    Article  Google Scholar 

  2. Hiatt JR, Gabbay J, Busuttil RW (1994) Surgical anatomy of the hepatic arteries in 1000 cases. Ann Surg 220(1):50–52. https://doi.org/10.1097/00000658-199407000-00008

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Yan SH, Yin YH, Jang JY et al (2007) Assessment of hepatic arterial anatomy in keeping with preservation of the vasculature while performing pancreatoduodenectomy: an opinion. World J Surg 31:2384–2391

    Article  Google Scholar 

  4. Northover JMA, Terblanche J (1979) A new look at the arterial supply of the bile duct in man and its surgical implications. Br J Surg 66(6):379–384. https://doi.org/10.1002/bjs.1800660603

    Article  CAS  PubMed  Google Scholar 

  5. Traverso LW, Freeny PC (1989) Pancreaticoduodenectomy: the importance of preserving hepatic blood flow to prevent biliary fistula. Am Surg 55(7):421–426

    CAS  PubMed  Google Scholar 

  6. Allendorf JD, Bellemare S (2009) Reconstruction of the replaced right hepatic artery at the time of pancreaticoduodenectomy. J Gastrointest Surg 13(3):555–557. https://doi.org/10.1007/s11605-008-0578-8

    Article  PubMed  Google Scholar 

  7. Jah A, Jamieson N, Huguet E, Praseedom R (2009) The implications of the presence of an aberrant right hepatic artery in patients undergoing a pancreaticoduodenectomy. Surg Today 39(8):669–674. https://doi.org/10.1007/s00595-009-3947-3

    Article  PubMed  Google Scholar 

  8. Turrini O, Wiebke EA, Delpero JR, Viret F, Lillemoe KD, Schmidt CM (2010) Preservation of replaced or accessory right hepatic artery during pancreaticoduodenectomy for adenocarcinoma: impact on margin status and survival. J Gastrointest Surg 14(11):1813–1819. https://doi.org/10.1007/s11605-010-1272-1

    Article  PubMed  Google Scholar 

  9. Cloyd JM, Chandra V, Louie JD (2012) Preoperative embolization of replaced right hepatic artery prior to pancreaticoduodenectomy. J Surg Oncol 106(4):509–512. https://doi.org/10.1002/jso.23082

    Article  PubMed  Google Scholar 

  10. El Amrani M, Leteurtre E, Sergent G, Ernst O, Maunoury V, Branche J, Pruvot FR, Truant S (2014) Pancreatic head carcinoma and right hepatic artery: embolization management—a case report. J Gastrointest Oncol 5(4):E80–E83. https://doi.org/10.3978/j.issn.2078-6891.2014.040

    PubMed  Google Scholar 

  11. Okada K, Kawai M, Hirono S et al (2015) A replaced right hepatic artery adjacent to pancreatic carcinoma should be divided to obtain R0 resection in pancreaticoduodenectomy. Langenbeck's Arch Surg 400(1):57–65. https://doi.org/10.1007/s00423-014-1255-x

    Article  Google Scholar 

  12. Tohma T, Cho A, Okazumi S, Makino H, Shuto K, Mochiduki R, Matsubara K, Gunji H, Ochiai T (2005) Communicating arcade between the right and left hepatic arteries: evaluation with CT and angiography during temporary balloon occlusion of the right or left hepatic artery. Radiology 237(1):361–365. https://doi.org/10.1148/radiol.2371040919

    Article  PubMed  Google Scholar 

  13. Gunji H, Cho A, Tohma T, Okazumi S, Makino H, Shuto K, Mochizuki R, Matsubara K, Hayano K, Mori C, Murakami G, Ochiai T (2006) The blood supply of the hilar bile duct and its relationship to the communicating arcade located between the right and left hepatic arteries. Am J Surg 192(3):276–280. https://doi.org/10.1016/j.amjsurg.2006.01.046

    Article  PubMed  Google Scholar 

  14. Noji T, Tsuchikawa T, Okamura K, Shichinohe T, Tanaka E, Hirano S (2014) Surgical outcome of hilar plate resection: extended hilar bile duct resection without hepatectomy. J Gastrointest Surg 18(6):1131–1137. https://doi.org/10.1007/s11605-014-2490-8

    Article  PubMed  Google Scholar 

  15. Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240(2):205–213. https://doi.org/10.1097/01.sla.0000133083.54934.ae

    Article  PubMed  PubMed Central  Google Scholar 

  16. Bassi C, Marchegiani G, Dervenis C, Sarr M, Abu Hilal M, Adham M, Allen P, Andersson R, Asbun HJ, Besselink MG, Conlon K, del Chiaro M, Falconi M, Fernandez-Cruz L, Fernandez-del Castillo C, Fingerhut A, Friess H, Gouma DJ, Hackert T, Izbicki J, Lillemoe KD, Neoptolemos JP, Olah A, Schulick R, Shrikhande SV, Takada T, Takaori K, Traverso W, Vollmer CR, Wolfgang CL, Yeo CJ, Salvia R, Buchler M, International Study Group on Pancreatic Surgery (ISGPS) (2017) The 2016 update of the International Study Group (ISGPS) definition and grading of postoperative pancreatic fistula: 11 years after. Surgery 161(3):584–591. https://doi.org/10.1016/j.surg.2016.11.014

    Article  PubMed  Google Scholar 

  17. Koch M, Garden OJ, Padbury R et al (2011) Bile leakage after hepatobiliary and pancreatic surgery: a definition and grading of severity by the International Study Group of Liver Surgery. Surgery 149:680–688

    Article  PubMed  Google Scholar 

  18. Shukla PJ, Barreto SG, Kulkarni A, Nagarajan G, Fingerhut A (2010) Vascular anomalies encountered during pancreatoduodenectomy: do they influence outcomes? Ann Surg Oncol 17(1):186–193. https://doi.org/10.1245/s10434-009-0757-1

    Article  PubMed  Google Scholar 

  19. Ogiso S, Conrad C, Araki K, Basso V, Gayet B (2013) Posterior approach for laparoscopic pancreaticoduodenectomy to prevent replaced hepatic artery injury. Ann Surg Oncol 20(9):3120. https://doi.org/10.1245/s10434-013-3058-7

    Article  PubMed  Google Scholar 

  20. Lardière-Deguelte S, Ragot E, Amroun K, Piardi T, Dokmak S, Bruno O, Appere F, Sibert A, Hoeffel C, Sommacale D, Kianmanesh R (2015) Hepatic abscess: diagnosis and management. J Visc Surg 152(4):231–243. https://doi.org/10.1016/j.jviscsurg.2015.01.013

    Article  PubMed  Google Scholar 

  21. Yeo CJ, Cameron JL, Sohn TA, Lillemoe KD, Pitt HA, Talamini MA, Hruban RH, Ord SE, Sauter PK, Coleman JA, Zahurak ML, Grochow LB, Abrams RA (1997) Six hundred fifty consecutive pancreaticoduodenectomies in the 1990s: pathology, complications, and outcomes. Ann Surg 226(3):248–257; discussion 257-260. https://doi.org/10.1097/00000658-199709000-00004

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Sakamoto I, Iwanaga S, Nagaoki K, Matsuoka Y, Ashizawa K, Uetani M, Fukuda T, Okimoto T, Okudaira S, Omagari K, Hayashi K, Matsunaga N (2003) Intrahepatic biloma formation (bile duct necrosis) after transcatheter arterial chemoembolization. AJR Am J Roentgenol 181(1):79–87. https://doi.org/10.2214/ajr.181.1.1810079

    Article  PubMed  Google Scholar 

  23. Noun R, Zeidan S, Tohme-Noun C (2006) Biliary ischemia following embolization of a pseudoaneurysm after pancreaticoduodenectomy. JOP 7(4):427–431

    PubMed  Google Scholar 

  24. Sanada Y, Kondo H, Goshima S et al (2010) Liver abscess after common hepatic artery embolization for delayed hemorrhage following pancreaticoduodenectomy: a case report. Case Rep Med 2010: Article ID 280430

  25. Njoku VC, Howard TJ, Shen C, Zyromski NJ, Schmidt CM, Pitt HA, Nakeeb A, Lillemoe KD (2014) Pyogenic liver abscess following pancreaticoduodenectomy: risk factors, treatment, and long-term outcome. J Gastrointest Surg 18(5):922–928. https://doi.org/10.1007/s11605-014-2466-8

    Article  PubMed  Google Scholar 

  26. Gaujoux S, Sauvanet A, Vullierme MP, Cortes A, Dokmak S, Sibert A, Vilgrain V, Belghiti J (2009) Ischemic complications after pancreaticoduodenectomy: incidence, prevention, and management. Ann Surg 249(1):111–117. https://doi.org/10.1097/SLA.0b013e3181930249

    Article  PubMed  Google Scholar 

  27. Hackert T, Stampfl U, Schulz H, Strobel O, Büchler MW, Werner J (2011) Clinical significance of liver ischaemia after pancreatic resection. Br J Surg 98(12):1760–1765. https://doi.org/10.1002/bjs.7675

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Gastroenterological Surgery II, Hokkaido University Graduate School of Medicine, West-7, North-15, Kita-ku, Sapporo, 060-8638, Japan

    Toshimichi Asano, Toru Nakamura, Takehiro Noji, Keisuke Okamura, Takahiro Tsuchikawa, Yoshitsugu Nakanishi, Kimitaka Tanaka, Soichi Murakami, Yuma Ebihara, Yo Kurashima, Toshiaki Shichinohe & Satoshi Hirano

Authors
  1. Toshimichi Asano
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Toru Nakamura
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Takehiro Noji
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Keisuke Okamura
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Takahiro Tsuchikawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Yoshitsugu Nakanishi
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Kimitaka Tanaka
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Soichi Murakami
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Yuma Ebihara
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Yo Kurashima
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Toshiaki Shichinohe
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Satoshi Hirano
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Toshimichi Asano: study conception and design, acquisition of data, analysis and interpretation of data, drafting of the manuscript, critical revision of the manuscript; Toru Nakamura: study conception and design, analysis and interpretation of data, drafting of the manuscript, critical revision of manuscript; Takehiro Noji: analysis and interpretation of data, critical revision of the manuscript; Keisuke Okamura: analysis and interpretation of data, critical revision of the manuscript; Takahiro Tsuchikawa: analysis and interpretation of data, critical revision of the manuscript; Yoshitsugu Nakanishi: acquisition of data, critical revision of the manuscript; Kimitaka Tanaka: acquisition of data, critical revision of the manuscript; Soichi Murakami: critical revision of the manuscript; Yuma Ebihara: analysis and interpretation of data, critical revision of the manuscript; Yo Kurashima: analysis and interpretation of data, critical revision of the manuscript; Toshiaki Shichinohe: critical revision of the manuscript; Satoshi Hirano: study conception and design, analysis and interpretation of data, drafting of the manuscript, critical revision of the manuscript

Corresponding author

Correspondence to Toru Nakamura.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

This retrospective study was conducted with the approval of the Hokkaido University Hospital Institutional Review Board (No. 016-0440).

Informed consent

Informed consent was obtained from all individual participants included in the study.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Asano, T., Nakamura, T., Noji, T. et al. Outcome of concomitant resection of the replaced right hepatic artery in pancreaticoduodenectomy without reconstruction. Langenbecks Arch Surg 403, 195–202 (2018). https://doi.org/10.1007/s00423-018-1650-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00423-018-1650-9

Keywords

Search

Navigation