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Hepatic artery resection without reconstruction in pancreatoduodenectomy

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Abstract

Purpose

It has been reported that there are left and right hepatic arterial arcades via the blood vessels around the hilar bile duct; therefore, when the hilar bile duct is preserved, hepatic artery reconstruction may not be necessary. We compared the short-term and long-term outcomes in patients with distal cholangiocarcinoma who underwent pancreatoduodenectomy (PD) with right hepatic artery resection without right hepatic artery reconstruction (RHAR group) with those patients who underwent conventional PD.

Methods

All data were retrospectively collected from patient records. A 1:4-propensity score-matched case-control study was conducted in patients with distal cholangiocarcinoma who received treatment at Tokyo Women’s Medical University from February 1985 to April 2015.

Results

There was no statistical difference in the overall morbidity rate between the two groups. No patient in the RHAR group (10 patients) had liver failure, liver abscess, or cholangitis in the postoperative period; one patient died postoperatively because of a bleeding pseudoaneurysm in the gastroduodenal artery. The PD group (40 patients) had a significantly better median time regarding the recurrence (34 vs. 11 months, p=0.027) and 5-year disease-free survival (35% vs. 10%, p=0.027) rates than the RHAR group, which may be attributed to the presence of a more severe disease in patients in the RHAR group.

Conclusion

We concluded that pancreaticoduodenectomy with right hepatic artery resection without reconstruction has a comparable overall morbidity rate with that of a conventional pancreaticoduodenectomy surgery and may be performed as an alternative procedure when tumor invasion of the right hepatic artery is suspected.

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Data availability

The data are available from the corresponding author upon reasonable request.

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Funding

This work was supported by the JSPS KAKENHI (Grant Number 18K08632). The funders had no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; and in the decision to submit the article for publication.

Author information

Authors and Affiliations

  1. Department of Surgery, Institute of Gastroenterology, Tokyo Women’s Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan

    Pipit Burasakarn, Ryota Higuchi, Takehisa Yazawa, Shuichiro Uemura, Wataru Izumo, Yutaro Matsunaga & Masakazu Yamamoto

  2. Division of HPB Surgery, Department of Surgery, Phramongkutklao Hospital, Bangkok, Thailand

    Pipit Burasakarn

Authors
  1. Pipit Burasakarn
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  2. Ryota Higuchi
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  3. Takehisa Yazawa
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  4. Shuichiro Uemura
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  5. Wataru Izumo
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  6. Yutaro Matsunaga
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  7. Masakazu Yamamoto
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Contributions

Study conception and design: Pipit Burasakarn, Ryota Higuchi, and Masakazu Yamamoto. Acquisition of data: Pipit Burasakarn, Ryota Higuchi, Takehisa Yazawa, Shuichiro Uemura, Wataru Izumo, Yutaro Matsunaga, and Masakazu Yamamoto. Analysis and interpretation of data: Pipit Burasakarn and Ryota Higuchi. Drafting of manuscript: Pipit Burasakarn and Ryota Higuchi. Critical revision of manuscript: Pipit Burasakarn, Ryota Higuchi, and Masakazu Yamamoto.

Corresponding author

Correspondence to Ryota Higuchi.

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Ethics approval

This study was approved by the institutional review board of Tokyo Women’s Medical University (approval number 4328-R2).

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The requirement to obtain written informed consent from each patient was waived because of the study’s retrospective design.

Consent for publication

The requirement to obtain written informed consent from each patient was waived because of the study’s retrospective design.

Competing interests

The authors declare no competing interests.

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Burasakarn, P., Higuchi, R., Yazawa, T. et al. Hepatic artery resection without reconstruction in pancreatoduodenectomy. Langenbecks Arch Surg 406, 2081–2090 (2021). https://doi.org/10.1007/s00423-021-02178-w

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  • DOI: https://doi.org/10.1007/s00423-021-02178-w

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