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Hepatic vascular anomalies during totally laparoscopic pancreaticoduodenectomy: challenging the challenge

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Abstract

The presence of hepatic vascular anomalies may add challenges to an already difficult surgery such as pancreatoduodenectomy, particularly when performed laparoscopically. Thus, our aim was to assess the impact of an aberrant right hepatic artery (aRHA) on postoperative outcomes during laparoscopic pancreatoduodenectomy (LPD) . Data of patients who underwent LPD were prospectively gathered and retrospectively analyzed. Patients with types III, IV, VI, VII, VIII, and IX anomalies according to Michels’ classification were included in the aRHA group and were compared with the remaining patients (nRHA group). 72 patients underwent LPD; 14 of these had an aRHA (19.4%). Except for BMI (p = 0.021), the two groups did not differ in terms of clinico-pathological characteristics. The two groups had similar postoperative complications (p = 0.123), pancreatic fistula (p = 0.790), biliary leakage (p = 0.209), postpancreatectomy hemorrhage (p = 0.790), reoperations (p = 0.416), and mortality (p = 0.312). The median number of lymph nodes harvested was higher in aRHA group (p = 0.032), while R0 resection rate was similar between groups (p = 0.635). At the multivariate analysis, only moderate/high FRS (OR 3.95, p = 0.039) was an independent predictor of postoperative complications. This study suggests that aRHA has no negative impact on surgical and oncological outcomes in patients undergoing LPD.

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

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Authors and Affiliations

  1. Division of Minimally-Invasive Surgical Oncology, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore, 3, 20162, Milan, Italy

    Alessandro Giani, Michele Mazzola, Lorenzo Morini, Andrea Zironda, Camillo Leonardo Bertoglio, Paolo De Martini, Carmelo Magistro & Giovanni Ferrari

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  1. Alessandro Giani
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  2. Michele Mazzola
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Contributions

AG, MM, and AZ conceived the study, participated in its design, and wrote the manuscript. AZ, LM, and MM performed the data collection. AG performed the statistical analysis. CLB, PDM, CM, and GF participated in the study conception, design and coordination, and in the interpretation of data. All authors revised the manuscript and approved the final version.

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Correspondence to Alessandro Giani.

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The Local Ethical Committee reviewed and approved the protocol (217-29042020).

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Informed consent was obtained from all individual participants included in the study.

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Giani, A., Mazzola, M., Morini, L. et al. Hepatic vascular anomalies during totally laparoscopic pancreaticoduodenectomy: challenging the challenge. Updates Surg 74, 583–590 (2022). https://doi.org/10.1007/s13304-021-01152-x

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