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Prognostic Effect of Aberrant Right Hepatic Artery with Pancreaticoduodenectomy: Focus on Hepatic Recurrence

  • Pancreatic Tumors
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Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Introduction

Metastatic progression occurs along the locoregional vasculature, and a common anatomic variant is an aberrant right hepatic artery (aRHA). This study evaluated the effect of an aRHA following pancreaticoduodenectomy, with a focus on hepatic metastases.

Methods

This was a single-institution retrospective review of non-metastatic pancreatic cancer cases between 2012 and 2020. aRHA cases were compared with patients with conventional anatomy. The primary outcome was hepatic recurrence rates, while secondary analysis survival outcomes were measured by overall survival (OS) and disease-free survival (DFS). Subgroup analysis was stratified by tumor resectability and utilization of systemic therapy.

Results

Overall, 207 cases were reviewed, with 17.4% having aRHA anatomy. On multivariate analysis, aRHA increased hepatic recurrence for all-comers (odds ratio [OR] 4.76, 95% confidence interval [CI] 2.18–10.38; p < 0.001). aRHA was significant for resectable tumors (OR 2.58, 95% CI 1.89–6.66; p = 0.045) and borderline resectable tumors (OR 28.88, 95% CI 5.52–151.18; p < 0.0001) in regard to hepatic recurrence on univariate analysis. Increased hepatic recurrence correlated with decreased 3-year OS and DFS rates of 30.6% versus 50.3% (OR 0.44, 95% CI 0.20–0.94; p = 0.032) and 13.6% versus 36.9% (OR 0.27, 95% CI 0.08–0.97; p = 0.035). Systemic therapy limited the effects of aRHA.

Conclusion

aRHA was associated with inferior survival outcomes due to the significantly increased risk of hepatic metastatic disease with aberrant anatomy. This study provides important prognostic information for a commonly encountered anatomic variant.

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Authors and Affiliations

  1. Department of Surgery, Surgical Oncology Section, Wake Forest University Baptist Medical Center, Winston-Salem, NC, USA

    Christopher W. Mangieri, Cristian D. Valenzuela, Richard A. Erali, Perry Shen, Russell Howerton & Clancy J. Clark

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  1. Christopher W. Mangieri
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  2. Cristian D. Valenzuela
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Correspondence to Christopher W. Mangieri.

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Christopher W. Mangieri, Cristian D. Valenzuela, Richard A. Erali, Perry Shen, Russell Howerton, and Clancy J. Clark have no conflicts of interest to declare.

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This is an original manuscript that has not been previously published. The manuscript has also not been submitted to another journal for consideration. This manuscript was presented at AHPBA 2021. None of the authors have any conflicts of interest.

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Mangieri, C.W., Valenzuela, C.D., Erali, R.A. et al. Prognostic Effect of Aberrant Right Hepatic Artery with Pancreaticoduodenectomy: Focus on Hepatic Recurrence. Ann Surg Oncol 29, 3219–3228 (2022). https://doi.org/10.1245/s10434-022-11341-6

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