Advertisement

World Journal of Surgery

, Volume 31, Issue 12, pp 2384–2391 | Cite as

Assessment of Hepatic Arterial Anatomy in Keeping with Preservation of the Vasculature While Performing Pancreatoduodenectomy: An Opinion

  • Sung Hoon YangEmail author
  • Yong Hu Yin
  • Jin-Young Jang
  • Seung Eun Lee
  • Jin Wook Chung
  • Kyung-Suk Suh
  • Kuhn Uk Lee
  • Sun-Whe Kim
Article

Abstract

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.

Keywords

Hepatic Artery Superior Mesenteric Artery Bloc Resection Superior Mesenteric Vein Common Hepatic Artery 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Acknowledgment

This study was supported by a grant (no. 0520320) from the National R&D Program for Cancer Control, Ministry of Health & Welfare, Republic of Korea.

References

  1. 1.
    Hiatt JR, Gabbay J, Busuttil RW (1994) Surgical anatomy of the hepatic arteries in 1000 cases. Ann Surg 220:50–52PubMedCrossRefGoogle Scholar
  2. 2.
    Michels NA (1966) Newer anatomy of the liver and its variant blood supply and collateral circulation. Am J Surg 112:337–347PubMedCrossRefGoogle Scholar
  3. 3.
    Koops A, Wojciechowski B, Broering DC, et al. (2004) Anatomic variations of the hepatic arteries in 604 selective celiac and superior mesenteric angiographies. Surg Radiol Anat 26:239–244PubMedCrossRefGoogle Scholar
  4. 4.
    Covey AM, Brody LA, Maluccio MA, et al. (2002) Variant hepatic arterial anatomy revisited: digital subtraction angiography performed in 600 patients. Radiology 224:542–547PubMedCrossRefGoogle Scholar
  5. 5.
    Kahraman G, Marur T, Tanyeli E, et al. (2001) Hepatomesenteric trunk. Surg Radiol Anat 23:433–435PubMedCrossRefGoogle Scholar
  6. 6.
    Higashi N, Hirai K (1995) On the hepatic artery arising from the superior mesenteric artery. Kaibogaku Zasshi 70:338–346PubMedGoogle Scholar
  7. 7.
    Yamamoto S, Kubota K, Rokkaku K, et al. (2005) Disposal of replaced common hepatic artery coursing within the pancreas during pancreatoduodenectomy: report of a case. Surg Today 35:984–987PubMedCrossRefGoogle Scholar
  8. 8.
    Volpe CM, Peterson S, Hoover EL, et al. (1998) Justification for visceral angiography prior to pancreaticoduodenectomy. Am Surg 64:758–761PubMedGoogle Scholar
  9. 9.
    Nakamura Y, Miyaki T, Hayashi S, et al. (2003) Three cases of the gastrosplenic and the hepatomesenteric trunks. Okajimas Folia Anat Jpn 80:71–76PubMedCrossRefGoogle Scholar
  10. 10.
    Hirai Y, Yamaki K, Saga T, et al. (2000) Two anomalous cases of the hepato-mesenteric and the gastro-splenic trunks independently arising from the abdominal aorta. Kurume Med J 47:249–252PubMedGoogle Scholar
  11. 11.
    Tseng JF, Raut CP, Lee JE, et al. (2004) Pancreaticoduodenectomy with vascular resection: margin status and survival duration. J Gastrointest Surg 8:935–949; discussion 949–950PubMedCrossRefGoogle Scholar
  12. 12.
    Tseng JF, Tamm EP, Lee JE, et al. (2006) Venous resection in pancreatic cancer surgery. Best Pract Res Clin Gastroenterol 20:349–364PubMedCrossRefGoogle Scholar
  13. 13.
    Nakano H, Kikuchi K, Seta S, et al. (2005) A patient undergoing pancreaticoduodenectomy in whom involved common hepatic artery anomalously arising from the superior mesenteric artery was removed and reconstructed. Hepatogastroenterology 52:1883–1885PubMedGoogle Scholar
  14. 14.
    Li B, Chen FZ, Ge XH, et al. (2004) Pancreatoduodenectomy with vascular reconstruction in treating carcinoma of the pancreatic head. Hepatobiliary Pancreat Dis Int 3:612–615PubMedGoogle Scholar
  15. 15.
    Nakano H, Bachellier P, Weber JC, et al. (2002) Arterial and vena caval resections combined with pancreaticoduodenectomy in highly selected patients with periampullary malignancies. Hepatogastroenterology 49:258–262PubMedGoogle Scholar
  16. 16.
    Settmacher U, Langrehr JM, Husmann I, et al. (2004) Reconstruction of visceral arteries with homografts in excision of the pancreas. Chirurg 75:1199–1206PubMedCrossRefGoogle Scholar
  17. 17.
    Kondo S, Katoh H, Hirano S, et al. (2003) Results of radical distal pancreatectomy with en bloc resection of the celiac artery for locally advanced cancer of the pancreatic body. Langenbecks Arch Surg 388:101–106PubMedCrossRefGoogle Scholar
  18. 18.
    Bold RJ, Charnsangavej C, Cleary KR, et al. (1999) Major vascular resection as part of pancreaticoduodenectomy for cancer: radiologic, intraoperative, and pathologic analysis. J Gastrointest Surg 3:233–243PubMedCrossRefGoogle Scholar
  19. 19.
    Ogata Y, Hishinuma S, Takahashi S, et al. (1997) Indication and results of pancreatectomy with combined resection of vessels for adenocarcinoma of the pancreas. Nippon Geka Gakkai Zasshi 98:615–621PubMedGoogle Scholar
  20. 20.
    Konishi M, Kinoshita T, Nakagori T, et al. (2000) Distal pancreatectomy with resection of the celiac axis and reconstruction of the hepatic artery for carcinoma of the body and tail of the pancreas. J Hepatobiliary Pancreat Surg 7:183–187PubMedCrossRefGoogle Scholar
  21. 21.
    Kondo S, Katoh H, Omi M, et al. (2001) Radical distal pancreatectomy with en bloc resection of the celiac artery, plexus, and ganglions for advanced cancer of the pancreatic body: a preliminary report on perfect pain relief. JOP 2:93–97PubMedGoogle Scholar
  22. 22.
    Woods MS, Traverso LW (1993) Sparing a replaced common hepatic artery during pancreaticoduodenectomy. Am Surg 59:719–721PubMedGoogle Scholar
  23. 23.
    Furukawa H, Shimada K, Iwata R, et al. (2000) A replaced common hepatic artery running through the pancreatic parenchyma. Surgery 127:711–712PubMedCrossRefGoogle Scholar
  24. 24.
    Kayaalp C, Nessar G, Kaman S, et al. (2001) Right liver necrosis: complication of laparoscopic cholecystectomy. Hepatogastroenterology 48:1727–1729PubMedGoogle Scholar
  25. 25.
    Miyazaki M, Ito H, Nakagawa K, et al. (2000) Unilateral hepatic artery reconstruction is unnecessary in biliary tract carcinomas involving lobar hepatic artery: implications of interlobar hepatic artery and its preservation. Hepatogastroenterology 47:1526–1530PubMedGoogle Scholar
  26. 26.
    Charnsangavej C, Chuang VP, Wallace S, et al. (1982) Angiographic classification of hepatic arterial collaterals. Radiology 144:485–494PubMedGoogle Scholar
  27. 27.
    Vellar ID (1999) The blood supply of the biliary ductal system and its relevance to vasculobiliary injuries following cholecystectomy. Aust N Z J Surg 69:816–820PubMedCrossRefGoogle Scholar
  28. 28.
    Alves A, Farges O, Nicolet J, et al. (2003) Incidence and consequence of a hepatic artery injury in patients with postcholecystectomy bile duct strictures. Ann Surg 238:93–96PubMedCrossRefGoogle Scholar
  29. 29.
    Miyamoto N, Kodama Y, Endo H, et al. (2004) Embolization of the replaced common hepatic artery before surgery for pancreatic head cancer: report of a case. Surg Today 34:619–622PubMedGoogle Scholar
  30. 30.
    Kondo S, Katoh H, Shimizu T, et al. (2000) Preoperative embolization of the common hepatic artery in preparation for radical pancreatectomy for pancreas body cancer. Hepatogastroenterology 47:1447–1449PubMedGoogle Scholar
  31. 31.
    Takeuchi Y, Arai Y, Inaba Y, et al. (1998) Extrahepatic arterial supply to the liver: observation with a unified CT and angiography system during temporary balloon occlusion of the proper hepatic artery. Radiology 209:121–128PubMedGoogle Scholar
  32. 32.
    Rong GH, Sindelar WF (1987) Aberrant peripancreatic arterial anatomy: considerations in performing pancreatectomy for malignant neoplasms. Am Surg 53:726–729PubMedGoogle Scholar
  33. 33.
    Endo I, Masunari H, Sugita M, et al. (2001) Indications for combined resection and reconstruction of the hepatic artery in biliary tract carcinoma. Nippon Geka Gakkai Zasshi 102:820–825PubMedGoogle Scholar
  34. 34.
    Kondo S, Ambo Y, Katoh H, et al. (2003) Middle colic artery-gastroepiploic artery bypass for compromised collateral flow in distal pancreatectomy with celiac artery resection. Hepatogastroenterology 50:305–307PubMedGoogle Scholar
  35. 35.
    Sarmiento JM, Panneton JM, Nagorney DM (2003) Reconstruction of the hepatic artery using the gastroduodenal artery. Am J Surg 185:386–387PubMedCrossRefGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2007

Authors and Affiliations

  • Sung Hoon Yang
    • 1
    Email author
  • Yong Hu Yin
    • 2
  • Jin-Young Jang
    • 1
  • Seung Eun Lee
    • 1
  • Jin Wook Chung
    • 2
  • Kyung-Suk Suh
    • 1
  • Kuhn Uk Lee
    • 1
  • Sun-Whe Kim
    • 1
  1. 1.Department of SurgerySeoul National University College of Medicine, Seoul National University HospitalSeoulKorea
  2. 2.Department of RadiologySeoul National University College of MedicineSeoulKorea

Personalised recommendations