Does Aberrant Right Hepatic Artery Influence the Surgical Short- and Long-term Outcome of Pancreatoduodenectomy?

Abstract

BACKGROUND:

Variations in vascular anatomy in pancreaticoduodenectomy for adenocarcinoma of the pancreatic head, aberrant right hepatic artery (αRHA) being the most frequent, may influence oncological outcome, surgical complexity, intra- and postoperative complications, and overall 5-year disease-free and survival rates.

MATERIALS AND METHODS:

Between January 1988 and January 2018, 297 consecutive patients underwent pancreaticoduodenectomy at our Institutions and were divided into two groups: Group 1 patients were affected with αRHA; group 2 were without this vascular anomaly. The groups were retrospectively compared to identify differences in preoperative characteristics and intraoperative course, postoperative morbidity and mortality and long-term disease-free interval and overall survival. Cox regression analysis was used to investigate the role of variables statistically significant at univariate analysis in the short- and long-term outcomes.

RESULTS:

Overall 44 (15%) patients had αRHA. No differences in patient characteristics were reported. The mean operative time was 451±58 minutes for group 1 and 317±27 minutes for group 2 (p<0.001), whereas mean blood losses were 729±488 ml and 508±119 ml, respectively (p<0.001). Group 1 patients had a longer stay in intensive care when compared to patients of group 2 (mean 5±2 versus 4±2 days, respectively; p<0.001). Furthermore group 1 patients had a significant longer hospitalization when compared to those of group 2 (mean 17±5 versus 15±3 days, respectively; p<0.006). No other significant differences were observed between the two groups. Cox regression analysis showed that independently of the presence of αRHA, the factors negatively affecting the 5-year survival rate were blood loss (p<0.001) and length of stay in intensive care (p<0.001).

DISCUSSION:

αRHA increases the surgical complexity of pancreatoduodenectomy, negatively affecting intraoperative blood loss, length of operation, length in intensive care and hospitalization, but does not influence long-term survival and disease-free rates.

• Authors: Daniele Crocetti, Paolo Sapienza, Paolo Ossola, Mariarita Tarallo, Giuseppe Cavallaro, Raffaele Serra, Raffaele Grande, Andrea Mingoli, Enrico Fiori, Giorgio DE Toma
• Journal: In vivo (Athens, Greece) (In Vivo) 2019 Jul-Aug Vol. 33 Issue 4 Pg. 1285-1292 ISSN: 1791-7549 [Electronic] Greece
• PMID: 31280220 (Publication Type: Journal Article)
• Copyright: Copyright© 2019, International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.

Topics

• Aged
• Aged, 80 and over
• Female
• Hepatic Artery (anatomy & histology, diagnostic imaging, pathology)
• Humans
• Male
• Middle Aged
• Neoplasm Grading
• Neoplasm Staging
• Odds Ratio
• Pancreatic Neoplasms (complications, diagnosis, mortality, surgery)
• Pancreaticoduodenectomy (adverse effects, methods)
• Postoperative Complications (etiology)
• Prognosis
• Proportional Hazards Models
• Survival Analysis
• Time Factors
• Treatment Outcome