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Hepatic artery resection and reconstruction using the right gastroepiploic artery during pancreaticoduodenectomy in advanced pancreatic cancer

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Surgical resection is the only curative treatment for pancreatic cancer. Arterial resection and reconstruction during pancreaticoduodenectomy for advanced pancreatic cancer remain controversial due to a high rate of complications.


We report two cases of pancreatic cancer with hepatic artery resection and reconstruction using the right gastroepiploic artery during pancreaticoduodenectomy after neoadjuvant therapy.


The patients underwent pancreaticoduodenectomy with resection of the right hepatic and common hepatic arteries. Achieving direct anastomosis was difficult; therefore, we planned hepatic artery reconstruction using the right gastroepiploic artery. We performed the reconstruction using an interrupted suture with end-to-end anastomosis. The first patient developed a postoperative pancreatic fistula, while the postoperative course of the second patient was uneventful. However, there were no adverse events related to the arterial reconstruction. R0 resection was achieved, and postoperative computed tomography revealed good patency of the reconstructed artery.


Hepatic artery reconstruction using the right gastroepiploic artery in pancreatic cancer might be technically safe and might become one of the alternative options.

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  1. Shindo Y, Hazama S, Suzuki N, Iguchi H, Uesugi K, Tanaka H, Aruga A, Hatori T, Ishizaki H, Umeda Y, Fujiwara T, Ikemoto T, Shimada M, Yoshimatsu K, Takenouchi H, Matsui H, Kanekiyo S, Iida M, Koki Y, Arima H, Furukawa H, Ueno T, Yoshino S, Fujita T, Kawakami Y, Nakamura Y, Oka M, Nagano H (2017) Predictive biomarkers for the efficacy of peptide vaccine treatment: based on the results of a phase II study on advanced pancreatic cancer. J Exp Clin Cancer Res 36(1):36.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Howard TJ, Krug JE, Yu J, Zyromski NJ, Schmidt CM, Jacobson LE, Madura JA, Wiebke EA, Lillemoe KD (2006) A margin-negative R0 resection accomplished with minimal postoperative complications is the surgeon's contribution to long-term survival in pancreatic cancer. J Gastrointest Surg 10(10):1338–1345; discussion 1345-1336.

    Article  PubMed  Google Scholar 

  3. Isaji S, Mizuno S, Windsor JA, Bassi C, Fernández-Del Castillo C, Hackert T, Hayasaki A, Katz MHG, Kim SW, Kishiwada M, Kitagawa H, Michalski CW, Wolfgang CL (2018) International consensus on definition and criteria of borderline resectable pancreatic ductal adenocarcinoma 2017. Pancreatology 18(1):2–11.

    Article  PubMed  Google Scholar 

  4. Murakami Y, Satoi S, Motoi F, Sho M, Kawai M, Matsumoto I, Honda G (2015) Portal or superior mesenteric vein resection in pancreatoduodenectomy for pancreatic head carcinoma. Br J Surg 102(7):837–846.

    Article  CAS  PubMed  Google Scholar 

  5. Dua MM, Tran TB, Klausner J, Hwa KJ, Poultsides GA, Norton JA, Visser BC (2015) Pancreatectomy with vein reconstruction: technique matters. HPB 17(9):824–831.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Mollberg N, Rahbari NN, Koch M, Hartwig W, Hoeger Y, Büchler MW, Weitz J (2011) Arterial resection during pancreatectomy for pancreatic cancer: a systematic review and meta-analysis. Ann Surg 254(6):882–893.

    Article  PubMed  Google Scholar 

  7. Yoshidome H, Shimizu H, Ohtsuka M, Yoshitomi H, Kato A, Furukawa K, Miyazaki M (2014) Pancreaticoduodenetomy combined with hepatic artery resection following preoperative hepatic arterial embolization. J Hepato-Biliary-Pancreat Sci 21(12):850–855.

    Article  Google Scholar 

  8. Amano H, Miura F, Toyota N, Wada K, Katoh K, Hayano K, Kadowaki S, Shibuya M, Maeno S, Eguchi T, Takada T, Asano T (2009) Is pancreatectomy with arterial reconstruction a safe and useful procedure for locally advanced pancreatic cancer? J Hepato-Biliary-Pancreat Surg 16(6):850–857.

    Article  Google Scholar 

  9. Bockhorn M, Burdelski C, Bogoevski D, Sgourakis G, Yekebas EF, Izbicki JR (2011) Arterial en bloc resection for pancreatic carcinoma. Br J Surg 98(1):86–92.

    Article  CAS  PubMed  Google Scholar 

  10. Matsui H, Hazama S, Sakamoto K, Shindo Y, Kanekiyo S, Nakashima M, Matsukuma S, Tokuhisa Y, Iida M, Suzuki N, Yoshimura K, Takeda S, Ueno T, Yoshino S, Oka M, Nagano H (2017) Postoperative adjuvant therapy for resectable pancreatic cancer with gemcitabine and adoptive immunotherapy. Pancreas 46(8):994–1002.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Marubashi S, Kobayashi S, Wada H, Kawamoto K, Eguchi H, Doki Y, Mori M, Nagano H (2013) Hepatic artery reconstruction in living donor liver transplantation: risk factor analysis of complication and a role of MDCT scan for detecting anastomotic stricture. World J Surg 37(11):2671–2677.

    Article  PubMed  Google Scholar 

  12. Evans DB, Rich TA, Byrd DR, Cleary KR, Connelly JH, Levin B, Charnsangavej C, Fenoglio CJ, Ames FC (1992) Preoperative chemoradiation and pancreaticoduodenectomy for adenocarcinoma of the pancreas. Archiv Surg 127(11):1335–1339.

    Article  CAS  Google Scholar 

  13. Clavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD, de Santibañes E, Pekolj J, Slankamenac K, Bassi C, Graf R, Vonlanthen R, Padbury R, Cameron JL, Makuuchi M (2009) The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg 250(2):187–196.

    Article  PubMed  Google Scholar 

  14. Ravikumar R, Sabin C, Abu Hilal M, Bramhall S, White S, Wigmore S, Imber CJ, Fusai G (2014) Portal vein resection in borderline resectable pancreatic cancer: a United Kingdom multicenter study. J Am Coll Surg 218(3):401–411.

    Article  PubMed  Google Scholar 

  15. Yoshitomi H, Kato A, Shimizu H, Ohtsuka M, Furukawa K, Takayashiki T, Kuboki S, Takano S, Okamura D, Suzuki D, Sakai N, Kagawa S, Miyazaki M (2014) Tips and tricks of surgical technique for pancreatic cancer: portal vein resection and reconstruction (with videos). J Hepato-Biliary-Pancreat Sci 21(9):E69–E74.

    Article  Google Scholar 

  16. Zhang Q, Wu J, Tian Y, Duan J, Shao Y, Yan S, Wang W (2019) Arterial resection and reconstruction in pancreatectomy: surgical technique and outcomes. BMC Surg 19(1):141.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Sarmiento JM, Panneton JM, Nagorney DM (2003) Reconstruction of the hepatic artery using the gastroduodenal artery. Am J Surg 185(4):386–387.

    Article  PubMed  Google Scholar 

  18. Klaiber U, Mihaljevic A, Hackert T (2019) Radical pancreatic cancer surgery-with arterial resection. Transl Gastroenterol Hepatol 4:8.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Hackert T, Weitz J, Büchler MW (2014) Splenic artery use for arterial reconstruction in pancreatic surgery. Langenbeck's Arch Surg 399(5):667–671.

    Article  Google Scholar 

  20. Kulkarni GV, Malinowski M, Hershberger R, Aranha GV (2013) Proper hepatic artery reconstruction with gastroduodenal artery transposition during pancreaticoduodenectomy. Perspect Vasc Surg Endovasc Ther 25(3-4):69–72.

    Article  PubMed  Google Scholar 

  21. Ahn CS, Hwang S, Moon DB, Song GW, Ha TY, Park GC, Namgoong JM, Yoon SY, Jung SW, Jung DH, Kim KH, Park YH, Park HW, Lee HJ, Park CS, Lee SG (2012) Right gastroepiploic artery is the first alternative inflow source for hepatic arterial reconstruction in living donor liver transplantation. Transplant Proc 44(2):451–453.

    Article  PubMed  Google Scholar 

  22. Suma H (2013) Gastroepiploic artery graft in coronary artery bypass grafting. Ann Cardiothorac Surg 2(4):493–498.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Li PC, Thorat A, Jeng LB, Yang HR, Li ML, Yeh CC, Chen TH, Hsu SC, Poon KS (2017) Hepatic artery reconstruction in living donor liver transplantation using surgical loupes: achieving low rate of hepatic arterial thrombosis in 741 consecutive recipients-tips and tricks to overcome the poor hepatic arterial flow. Liver Transpl 23(7):887–898.

    Article  PubMed  Google Scholar 

  24. Radermecker MA, Honore P, Dekoster G, Dewandre JM, Thoorens P, Jacquet N, Meurisse M (1993) Successful revascularization of an orthotopic liver transplant (OLT) with the recipient right gastroepiploic artery. Clin Transpl 7(1 part 1):33–36

    CAS  Google Scholar 

  25. Steinbrück K, Fernandes R, Enne M, Vasconcelos R, Bento G, Stoduto G, Auel T, Pacheco-Moreira LF (2014) Right gastroepiploic artery as an alternative for arterial reconstruction in living donor liver transplantation. Case Rep Hepatol 2014:616251–616253.

    Article  Google Scholar 

  26. Katz MH, Marsh R, Herman JM, Shi Q, Collison E, Venook AP, Kindler HL, Alberts SR, Philip P, Lowy AM, Pisters PW, Posner MC, Berlin JD, Ahmad SA (2013) Borderline resectable pancreatic cancer: need for standardization and methods for optimal clinical trial design. Ann Surg Oncol 20(8):2787–2795.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Bonds M, Rocha FG (2019) Contemporary review of borderline resectable pancreatic ductal adenocarcinoma. J Clin Med 8(8).

  28. Petrelli F, Coinu A, Borgonovo K, Cabiddu M, Ghilardi M, Lonati V, Aitini E, Barni S (2015) FOLFIRINOX-based neoadjuvant therapy in borderline resectable or unresectable pancreatic cancer: a meta-analytical review of published studies. Pancreas 44(4):515–521.

    Article  CAS  PubMed  Google Scholar 

  29. Ielpo B, Caruso R, Duran H, Diaz E, Fabra I, Malavé L, Ferri V, Alvarez R, Cubillo A, Plaza C, Lazzaro S, Kalivaci D, Quijano Y, Vicente E (2017) A comparative study of neoadjuvant treatment with gemcitabine plus nab-paclitaxel versus surgery first for pancreatic adenocarcinoma. Surg Oncol 26(4):402–410.

    Article  PubMed  Google Scholar 

  30. Motoi F, Unno M (2020) Neoadjuvant treatment for resectable pancreatic adenocarcinoma: What is the best protocol? Ann Gastroenterol Surg 4(2):100–108.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Hackert T (2018) Surgery for pancreatic cancer after neoadjuvant treatment. Ann Gastroenterol Surg 2(6):413–418.

    Article  PubMed  PubMed Central  Google Scholar 

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We would like to thank Tatsuya Ioka for the useful discussions.

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Authors and Affiliations



YS, YT, SM, ST, and HN participated in the study conception and design. YS, HM, and YH participated in the acquisition of data. YS, MN, NS, and YH participated in the analysis and interpretation of the data. YS, SM, and HM participated in the drafting of the manuscript. YS, YT, SM, HM, MN, NS, ST, YH, and HN participated in the critical revision of the manuscript.

Corresponding author

Correspondence to Hiroaki Nagano.

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The study was carried out in accordance with the Declaration of Helsinki and was approved by the Institutional Review Boards of Yamaguchi University Hospital (number H2020-012). Written informed consent was obtained from all patients in this study.

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The authors declare no competing interests.

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Shindo, Y., Tokumitsu, Y., Matsukuma, S. et al. Hepatic artery resection and reconstruction using the right gastroepiploic artery during pancreaticoduodenectomy in advanced pancreatic cancer. Langenbecks Arch Surg 406, 2075–2080 (2021).

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