Outcome of concomitant resection of the replaced right hepatic artery in pancreaticoduodenectomy without reconstruction
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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.
We retrospectively analyzed 323 consecutive patients who underwent PD.
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.
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.
KeywordsReplaced right hepatic artery Pancreaticoduodenectomy Hepatic abscess Complication
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
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
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 was obtained from all individual participants included in the study.
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