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Prepancreatic common hepatic artery arising from superior mesenteric artery: an exceptional but important finding during pancreaticoduodenectomy

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Abstract

Purpose

The hepato-mesenteric trunk is an extremely rare condition in which the common hepatic artery (CHA) originates from the superior mesenteric artery (SMA). Usually, CHA passes behind the head of the pancreas. A systematic review was performed to provide guidelines for the perioperative management of patients with this anatomical variation who underwent a pancreaticoduodenectomy (PD). A case report was also included.

Methods

A systematic search of the literature was conducted and the manuscript was structured following point-by-point the PRISMA guidelines. The risk of bias within individual studies was assessed using the Joanna Briggs Institute Critical Appraisal Checklist tools. Case report was structured according to the CARE guidelines.

Results

After an initial selection of 141 titles, 9 articles were included in the study (n = 10 patients). A postoperative surgical complication which required a reintervention occurred only one time. In four patients, CHA had a posterior position relative to pancreas, while in three cases, it was anterior. The remaining three patients had an intrapancreatic course. The CHA was resected in two patients, with an end-to-end reconstruction or using the splenic artery stump. In only three patients, a preoperative multidisciplinary presentation was performed and in four cases, the CHA variation was not described by radiologists in formal CT-scan reports.

Conclusion

Although there are no definitive guidelines, improvements in the preoperative knowledge of such a rare anatomical variation may ensure better postoperative outcomes, avoiding intraoperative accidents and life-threatening postoperative complications.

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Data availability

The authors confirm that the data supporting the findings of this study are available within the article and its supplementary materials.

References

  1. Braşoveanu V, Dumitraşcu T, Bacalbaşa N, Zamfir R (2009) Splenic artery used for replaced common hepatic artery reconstruction during pancreatoduodenectomy–a case report. Chirurgia (Bucur) 104:499–504

    Google Scholar 

  2. Chamberlain RS, El-Sedfy A, Rajkumar D (2011) Aberrant hepatic arterial anatomy and the whipple procedure: lessons learned. Am Surg 77:517–526

    Article  PubMed  Google Scholar 

  3. CreTu OM, Hut EF, Dan RG, Munteanu M, Totolici BD, Andercou OA (2017) Replaced common hepatic artery originating from the superior mesenteric artery and prepancreatic, anterior course in a patient with cephalic pancreaticoduodenectomy—case report. Rom J Morphol Embryol 58:553–556

    PubMed  Google Scholar 

  4. Cruzes DS, Dybå T, Runeson P, Höst M (2015) Case studies synthesis: a thematic, cross-case, and narrative synthesis worked example. Empir Softw Eng 20:1634–1665

    Article  Google Scholar 

  5. Cumpston M, Li T, Page MJ et al (2019) Updated guidance for trusted systematic reviews: a new edition of the Cochrane Handbook for Systematic Reviews of Interventions. Cochrane Database Syst Rev 10:Ed000142

  6. Desai GS, Pande P, Shah RC, Jagannath P (2019) Pancreaticoduodenectomy with replaced common hepatic artery and portal vein reconstruction in primary carcinoma duodenum: a case report and literature review. J Gastrointestinal Cancer 50:684–688

    Article  Google Scholar 

  7. Diaz A, Paredes AZ, Hyer JM, Pawlik TM (2020) Variation in value among hospitals performing complex cancer operations. Surgery 168:106–112

    Article  PubMed  Google Scholar 

  8. Egorov VI, Yashina NI, Fedorov AV, Karmazanovsky GG, Vishnevsky VA, Shevchenko TV (2010) Celiaco-mesenterial arterial aberrations in patients undergoing extended pancreatic resections: correlation of CT angiography with findings at surgery. JOP 11:348–357

    PubMed  Google Scholar 

  9. Farghadani M, Momeni M, Hekmatnia A, Momeni F, Baradaran Mahdavi MM (2016) Anatomical variation of celiac axis, superior mesenteric artery, and hepatic artery: evaluation with multidetector computed tomography angiography. J Res Med Sci 21:129

    Article  PubMed  PubMed Central  Google Scholar 

  10. Hackert T, Schneider L, Büchler MW (2015) Current state of vascular resections in pancreatic cancer surgery. Gastroenterol Res Pract 2015:120207

    Article  PubMed  PubMed Central  Google Scholar 

  11. Haller Av (1756) Icones anatomicae in quibus aliquae partes corporis humani delineatae proponuntur et arteriarum potissimum historia continetur. Gottingae: Apud viduam B. Abrami Vandenhoeckii

  12. Hiatt JR, Gabbay J, Busuttil RW (1994) Surgical anatomy of the hepatic arteries in 1000 cases. Ann Surg 220:50–52

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Huang Y, Liu C, Lin JL (2013) Clinical significance of hepatic artery variations originating from the superior mesenteric artery in abdominal tumor surgery. Chin Med J (Engl) 126:899–902

    Google Scholar 

  14. Hutton B, Salanti G, Caldwell DM et al (2015) The PRISMA extension statement for reporting of systematic reviews incorporating network meta-analyses of health care interventions: checklist and explanations. Ann Intern Med 162:777–784

    Article  PubMed  Google Scholar 

  15. Inoue Y, Saiura A, Tanaka M et al (2016) Technical details of an anterior approach to the superior mesenteric artery during pancreaticoduodenectomy. J Gastrointest Surg 20(10):1769–1777

    Article  PubMed  Google Scholar 

  16. 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 39:669–674

    Article  PubMed  Google Scholar 

  17. Kausch W (1912) Das Carcinom der Papilla duodeni und seine radikale Entfernung. Beitr Klin Chir 78:439–486

    Google Scholar 

  18. Lupaşcu C, Moldovanu R, Andronic D et al (2011) Posterior approach pancreaticoduodenectomy: best option for hepatic artery anatomical variants. Hepatogastroenterology 58:2112–2114

    PubMed  Google Scholar 

  19. Michels NA (1966) Newer anatomy of the liver and its variant blood supply and collateral circulation. Am J Surg 112:337–347

    Article  CAS  PubMed  Google Scholar 

  20. 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 34:619–622

    PubMed  Google Scholar 

  21. Moszkowicz D, Peschaud F, El Hajjam M, Saiag P, Nordlinger B (2011) Preservation of an intra-pancreatic hepatic artery during duodenopancreatectomy for melanoma metastasis. Surg Radiol Anat 33:547–550

    Article  PubMed  Google Scholar 

  22. Müller P, Randhawa K, Roberts KJ (2014) Preoperative identification of anomalous arterial anatomy at pancreaticoduodenectomy. Ann R Coll Surg Engl 96:e34–e36

    Article  PubMed  PubMed Central  Google Scholar 

  23. Munn Z, Barker TH, Moola S et al (2019) Methodological quality of case series studies: an introduction to the JBI critical appraisal tool. JBI Database System Rev Implement Rep 18(10):2127–2133

    Google Scholar 

  24. Murad MH, Sultan S, Haffar S, Bazerbachi F (2018) Methodological quality and synthesis of case series and case reports. BMJ Evid Based Med 23:60–63

    Article  PubMed  PubMed Central  Google Scholar 

  25. Muttillo EM, Felli E, Pessaux P (2020) Cattell-Braasch maneuver in pancreatic surgery. No need of venous graft for vascular resection. J Surg Oncol 122:1612–1615

    Article  PubMed  Google Scholar 

  26. 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 52:1883–1885

    PubMed  Google Scholar 

  27. Peparini N, Chirletti P (2013) Mesopancreas: a boundless structure, namely R1 risk in pancreaticoduodenectomy for pancreatic head carcinoma. Eur J Surg Oncol 39:1303–1308

    Article  CAS  PubMed  Google Scholar 

  28. Rammohan A, Sathyanesan J, Palaniappan R, Govindan M (2013) Transpancreatic hepatomesenteric trunk complicating pancreaticoduodenectomy. JOP 14:649–652

    PubMed  Google Scholar 

  29. Rubio-Manzanares-Dorado M, Marín-Gómez LM, Aparicio-Sánchez D et al (2015) Implication of the presence of a variant hepatic artery during the Whipple procedure. Rev Esp Enferm Dig 107:417–422

    Article  PubMed  Google Scholar 

  30. Sanjay P, Takaori K, Govil S, Shrikhande SV, Windsor JA (2012) “Artery-first” approaches to pancreatoduodenectomy. Br J Surg 99:1027–1035

    Article  CAS  PubMed  Google Scholar 

  31. Sayre JW, Toklu HZ, Ye F, Mazza J, Yale S (2017) Case reports, case series—from clinical practice to evidence-based medicine in graduate medical education. Cureus 9:e1546

    PubMed  PubMed Central  Google Scholar 

  32. Shukla PJ, Barreto SG, Kulkarni A, Nagarajan G, Fingerhut A (2010) Vascular anomalies encountered during pancreatoduodenectomy: do they influence outcomes? Ann Surg Oncol 17:186–193

    Article  PubMed  Google Scholar 

  33. Song SY, Chung JW, Yin YH et al (2010) Celiac axis and common hepatic artery variations in 5002 patients: systematic analysis with spiral CT and DSA. Radiology 255:278–288

    Article  PubMed  Google Scholar 

  34. Stauffer JA, Bridges MD, Turan N, Nguyen JH, Martin JK (2009) Aberrant right hepatic arterial anatomy and pancreaticoduodenectomy: recognition, prevalence and management. HPB (Oxford) 11:161–165

    Article  Google Scholar 

  35. Thangarajah A, Parthasarathy R (2016) Celiac axis, common hepatic and hepatic artery variants as evidenced on MDCT angiography in South Indian population. J Clin Diagn Res 10:Tc01-5

    PubMed  Google Scholar 

  36. van Roessel S, Kasumova GG, Verheij J et al (2018) International validation of the eighth edition of the American Joint Committee on Cancer (AJCC) TNM staging system in patients with resected pancreatic cancer. JAMA Surg 153:e183617.8

  37. Volpe CM, Peterson S, Hoover EL, Doerr RJ (1998) Justification for visceral angiography prior to pancreaticoduodenectomy. Am Surg 64:758–761

    CAS  PubMed  Google Scholar 

  38. Vonlanthen R, Slankamenac K, Breitenstein S et al (2011) The impact of complications on costs of major surgical procedures: a cost analysis of 1200 patients. Ann Surg 254:907–913

    Article  PubMed  Google Scholar 

  39. Whipple AO, Parsons WB, Mullins CR (1935) Treatment of carcinoma of the ampulla of Vater. Ann Surg 102:763–779

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  40. Wood M, Lazo C, Hassid V, Awad ZT (2012) Replaced common hepatic artery from superior mesenteric artery during pancreaticoduodenectomy. Gulf J Oncolog 11:60–62

    Google Scholar 

  41. Woods MS, Traverso LW (1993) Sparing a replaced common hepatic artery during pancreaticoduodenectomy. Am Surg 59:719–721

    CAS  PubMed  Google Scholar 

  42. Yamamoto S, Kubota K, Rokkaku K, Nemoto T, Sakuma A (2005) Disposal of replaced common hepatic artery coursing within the pancreas during pancreatoduodenectomy: report of a case. Surg Today 35:984–987

    Article  PubMed  Google Scholar 

  43. Yang J, Fang CH, Fan YF et al (2014) To assess the benefits of medical image three-dimensional visualization system assisted pancreaticoduodenctomy for patients with hepatic artery variance. Int J Med Robot 10:410–417

    Article  PubMed  Google Scholar 

  44. Younan G, Tsai S, Evans DB, Christians KK (2016) Techniques of vascular resection and reconstruction in pancreatic cancer. Surg Clin North Am 96:1351–1370

    Article  PubMed  Google Scholar 

  45. Zarzavadjian Le Bian A, Costi R, Blangy S, Sbai-Idrissi MS, Smadja C (2015) Pancreaticoduodenectomy in the presence of a common hepatic artery originating from the superior mesenteric artery. Technical implications Int J Surg 17:1–4

    PubMed  Google Scholar 

Download references

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Author information

Authors and Affiliations

  1. IRCCS San Raffaele Scientific Institute, Milan, Italy

    Lorenzo Cinelli

  2. Research Institute Against Digestive Cancer (IRCAD), Strasbourg, France

    Lorenzo Cinelli & Michele Diana

  3. Hepatology, Department of Biomedical Research, Inselspital, Bern University, Bern, Switzerland

    Eric Felli

  4. Department of Surgical Sciences, Sapienza University of Rome, Rome, Italy

    Edoardo Maria Muttillo

  5. Hepatobiliary Surgery Division, IRCCS San Raffaele Hospital, Milan, Italy

    Guido Fiorentini

  6. University of Strasbourg, Strasbourg, France

    Michele Diana

  7. HPB Unit, Digestive Surgery Department, Nouvel Hopital Civil, University of Strasbourg, 1 Place de l’Hôpital, 67091, Strasbourg, France

    Patrick Pessaux & Emanuele Felli

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  1. Lorenzo Cinelli
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  7. Emanuele Felli
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Contributions

All the authors take responsibility for the integrity of the data and the accuracy of the data analysis. LC: Protocol/Project development, data collection and management, data analysis, manuscript writing and editing, and critical revision of the manuscript. ErF: Protocol/Project development, data management, data analysis, manuscript writing and editing, and critical revision of the manuscript. EMM: Project development, data management, data analysis, manuscript editing, and critical revision of the manuscript. GF: Project development, data management, data analysis, manuscript editing, and critical revision of the manuscript. MD: Project development, data management, data analysis, manuscript editing, and critical revision of the manuscript. PP: Project development, data management, data analysis, manuscript editing, and critical revision of the manuscript. EmF: Protocol/Project development, data management, data analysis, manuscript writing and editing, and critical revision of the manuscript. All the authors approved the final version of the manuscript.

Corresponding author

Correspondence to Emanuele Felli.

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Cinelli, L., Felli, E., Muttillo, E.M. et al. Prepancreatic common hepatic artery arising from superior mesenteric artery: an exceptional but important finding during pancreaticoduodenectomy. Surg Radiol Anat 43, 1413–1420 (2021). https://doi.org/10.1007/s00276-021-02786-7

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