Impact of the aberrant right hepatic artery on local recurrence of pancreatic ductal adenocarcinoma after pancreaticoduodenectomy

• Published in: Surgery 2022-08, Vol.172 (2), p.691-699
• Main Authors: Nakajima, Takayoshi, Ikuta, Shinichi, Nakamura, Ikuo, Aihara, Tsukasa, Kasai, Meidai, Iwama, Hideaki, Fujimoto, Yasuhiro, Hatano, Etsuro, Yamanaka, Naoki
• Format: Article
• Language: English
• Subjects: Carcinoma, Pancreatic Ductal - pathology; Hepatic Artery - pathology; Hepatic Artery - surgery; Humans; Neoplasm Recurrence, Local - pathology; Pancreatic Neoplasms; Pancreaticoduodenectomy; Retrospective Studies
• ISSN: 0039-6060; 1532-7361
• DOI: 10.1016/j.surg.2022.02.010

The influence and risk associated with an aberrant right hepatic artery, a common anatomical variation, during pancreatoduodenectomy for pancreatic ductal adenocarcinoma has not been fully investigated. The present study analyzed the impact of an aberrant right hepatic artery on local recurrence after pancreatoduodenectomy for pancreatic ductal adenocarcinoma. A total of 169 patients with pancreatic ductal adenocarcinoma who underwent pancreatoduodenectomy at 2 separate Japanese medical institutions were retrospectively analyzed. Thirty of 169 patients (17.7%) presented with an aberrant right hepatic artery. The incidence of local recurrence was higher in the aberrant right hepatic artery group than in the normal right hepatic artery group (43.3 vs 21.5%, P = .017). The local recurrence-free survival was significantly poorer in the aberrant right hepatic artery group than in the normal right hepatic artery group (P = .011). A multivariate analysis found that the aberrant right hepatic artery was an independent risk factor for local recurrence (hazard ratio: 3.74, P = .017). In the aberrant right hepatic artery group, more frequent local recurrence was observed in patients with tumors situated ≤10 mm from the aberrant right hepatic artery root. However, local recurrence was not observed in 2 out of 3 patients with tumors ≤10 mm from the aberrant right hepatic artery root who underwent pancreatoduodenectomy with combined resection of the aberrant right hepatic artery. The presence of an aberrant right hepatic artery in patients undergoing pancreatoduodenectomy for pancreatic ductal adenocarcinoma may be associated with an increased risk of postoperative local recurrence. Combined resection of the aberrant right hepatic artery may reduce local recurrence, especially for tumors near the root of the aberrant right hepatic artery.