Volume 8, Issue 1, February 2020, Page: 5-8
Implications of Arterial Variations in Pancreatoduodenectomy for Cancer
Silvio Marcio Pegoraro Balzan, Department of Biology and Pharmacy (Liga Acadêmica do Cancer), University of Santa Cruz do Sul (UNISC), Santa Cruz do Sul, Brazil; Saint Gallen Institute of Oncology, Santa Cruz do Sul, Brazil; Oncology Center Lydia Wong Ling (Moinhos de Vento Hospital), Porto Alegre, Brazil
Vinicius Grando Gava, Oncology Center Lydia Wong Ling (Moinhos de Vento Hospital), Porto Alegre, Brazil
Érika Luiza Maschio, Department of Biology and Pharmacy (Liga Acadêmica do Cancer), University of Santa Cruz do Sul (UNISC), Santa Cruz do Sul, Brazil
Victoria Lucateli Bernardi, Department of Biology and Pharmacy (Liga Acadêmica do Cancer), University of Santa Cruz do Sul (UNISC), Santa Cruz do Sul, Brazil
Giana da Silva Lima, Department of Biology and Pharmacy (Liga Acadêmica do Cancer), University of Santa Cruz do Sul (UNISC), Santa Cruz do Sul, Brazil
Graziela de Gasperi, Department of Biology and Pharmacy (Liga Acadêmica do Cancer), University of Santa Cruz do Sul (UNISC), Santa Cruz do Sul, Brazil
Morgana Pizzolatti Marins, Department of Biology and Pharmacy (Liga Acadêmica do Cancer), University of Santa Cruz do Sul (UNISC), Santa Cruz do Sul, Brazil
Vanessa Batistella Kunzler, Department of Biology and Pharmacy (Liga Acadêmica do Cancer), University of Santa Cruz do Sul (UNISC), Santa Cruz do Sul, Brazil
Bruna Aparecida Fontana Costa, Department of Biology and Pharmacy (Liga Acadêmica do Cancer), University of Santa Cruz do Sul (UNISC), Santa Cruz do Sul, Brazil
Received: Nov. 10, 2019;       Accepted: Jan. 2, 2020;       Published: Jan. 17, 2020
DOI: 10.11648/j.js.201200801.12      View  50      Downloads  43
Pancreatoduodenectomy for cancer is a complex surgical procedure with significant morbidity and mortality. Technical aspects of this procedure typically comprise dissection of celiac trunk, the common and the proper hepatic arteries. The presence of hepatic arterial anomalies is not uncommon and influences surgical technique. An aberrant right hepatic artery (replaced or accessory) or a common hepatic artery originating from the superior mesenteric artery are present in nearly 13% of cases and usually run in contact with the posterior aspect of the head of the pancreas. These anomalous arteries are at risk of iatrogenic injury and tumor involvement. Iatrogenic vascular lesions can lead to bleeding and/or ischemic complications, such as anastomotic stenosis, hepatic abscess and liver failure. Also, vascular tumor involvement might require arterial resection and reconstruction. The presence of arterial variations should not affect the radicalness of pancreatic resection as the involvement of aberrant arteries does not seem to affect postoperative outcomes or overall survival. These vascular variations should be, preferably, recognized pre-operatively in order to define possible surgical strategies. Preoperative contrast enhanced computed tomography provides accurate arterial anatomy evaluation. Lastly, aberrant hepatic arteries require proper dissection and/or occasionally resection and reconstruction during pancreatoduodenectomy to achieve a safe resection with proper radicalness. Knowledge of arterial variations is crucial for pancreatic cancer surgery.
Pancreatic Cancer, Pancreatoduodenectomy, Arterial Variations, Pancreatic Surgery
To cite this article
Silvio Marcio Pegoraro Balzan, Vinicius Grando Gava, Érika Luiza Maschio, Victoria Lucateli Bernardi, Giana da Silva Lima, Graziela de Gasperi, Morgana Pizzolatti Marins, Vanessa Batistella Kunzler, Bruna Aparecida Fontana Costa, Implications of Arterial Variations in Pancreatoduodenectomy for Cancer, Journal of Surgery. Vol. 8, No. 1, 2020, pp. 5-8. doi: 10.11648/j.js.201200801.12
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This article is an open access article distributed under the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Reames BN, Blair AB, Krell RW, Groot VP, Gemenetzis G, Padussis JC, et al. Management of Locally Advanced Pancreatic Cancer. Ann Surg 2019: 1. https://doi.org/10.1097/SLA.0000000000003568.
Noussios G, Dimitriou I, Chatzis I, Katsourakis A. The Main Anatomic Variations of the Hepatic Artery and Their Importance in Surgical Practice: Review of the Literature. J Clin Med Res 2017; 9: 248–52. https://doi.org/10.14740/jocmr2902w.
Narayanan S, Martin AN, Turrentine FE, Bauer TW, Adams RB, Zaydfudim VM. Mortality after pancreaticoduodenectomy: assessing early and late causes of patient death. J Surg Res 2018; 231: 304–8. https://doi.org/10.1016/j.jss.2018.05.075.
Pallisera A, Morales R, Ramia JM. Tricks and tips in pancreatoduodenectomy. World J Gastrointest Oncol 2014; 6: 344–50. https://doi.org/10.4251/wjgo.v6.i9.344.
Sabesan A, Gough BL, Anderson C, Abdel-Misih R, Petrelli NJ, Bennett JJ. High volume pancreaticoduodenectomy performed at an academic community cancer center. Am J Surg 2018. https://doi.org/10.1016/j.amjsurg.2018.10.041.
Balzan SMP, Gava VG, Pedrotti S, Magalhães MA, Schwengber A, Dotto ML, et al. PREVALENCE OF HEPATIC ARTERIAL VARIATIONS WITH IMPLICATIONS IN PANCREATODUODENECTOMY. Arq Bras Cir Dig 2019; 32: e1455. https://doi.org/10.1590/0102-672020190001e1455.
Koops A, Wojciechowski B, Broering DC, Adam G, Krupski-Berdien G. Anatomic variations of the hepatic arteries in 604 selective celiac and superior mesenteric angiographies. Surg Radiol Anat 2004; 26: 239–44. https://doi.org/10.1007/s00276-004-0229-z.
Alexakis N, Bramis K, Toutouzas K, Zografos G, Konstadoulakis M. Variant hepatic arterial anatomy encountered during pancreatoduodenectomy does not influence postoperative outcomes or resection margin status: A matched pair analysis of 105 patients. J Surg Oncol 2019; 119: 1122–7. https://doi.org/10.1002/jso.25461.
Whipple AO, Parsons WB, Mullins CR. TREATMENT OF CARCINOMA OF THE AMPULLA OF VATER. Ann Surg 1935; 102: 763–79.
Patel H, Chaudhary N, Nundy S. Pancreaticoduodenectomy: Techniques and controversies. Curr Med Res Pract 2014; 4: 274–83. https://doi.org/10.1016/j.cmrp.2014.11.007.
Malgras B, Ezanno AC, Dokmak S. Lymphadenectomy of the hepatic pedicle during hepato-pancreato-biliary surgery. J Visc Surg 2018; 155: 219–22. https://doi.org/10.1016/j.jviscsurg.2018.03.015.
Marco-Clement I, Martinez-Barco A, Ahumada N, Simon C, Valderrama JM, Sanudo J, et al. Anatomical variations of the celiac trunk: cadaveric and radiological study. Surg Radiol Anat 2016; 38: 501–10. https://doi.org/10.1007/s00276-015-1542-4.
SANTOS PV dos, BARBOSA ABM, TARGINO VA, SILVA N de A, SILVA YC de M, BARBOSA F, et al. ANATOMICAL VARIATIONS OF THE CELIAC TRUNK: A SYSTEMATIC REVIEW. ABCD Arq Bras Cir Dig (São Paulo) 2018. https://doi.org/10.1590/0102-672020180001e1403.
Zagyapan R, Kurkcuoglu A, Bayraktar A, Pelin C, Aytekin C. Anatomic variations of the celiac trunk and hepatic arterial system with digital subtraction angiography. Turkish J Gastroenterol 2015; 25: 104–9. https://doi.org/10.5152/tjg.2014.5406.
Ferrari R, De Cecco CN, Iafrate F, Paolantonio P, Rengo M, Laghi A. Studio sulla variabilità anatomica del tripode celiaco e delle arterie mesenteriche mediante angiografia con TC spirale multistrato a 64 strati. Radiol Medica 2007; 112: 988–98. https://doi.org/10.1007/s11547-007-0200-2.
Agarwal S, Pangtey B, Vasudeva N. Unusual variation in the branching pattern of the celiac trunk and its embryological and clinical perspective. J Clin Diagnostic Res 2016; 10: AD05–7. https://doi.org/10.7860/JCDR/2016/19527.8064.
Hiatt JR, Gabbay J, Busuttil RW. Surgical anatomy of the hepatic arteries in 1000 cases. Ann Surg 1994; 220: 50–2.
CreŢu OM, Hut EF, Dan RG, Munteanu M, Totolici BD, Andercou OA. Replaced common hepatic artery originating from the superior mesenteric artery and prepancreatic, anterior course in a patient with cephalic pancreaticoduodenectomy - case report. Rom J Morphol Embryol 2017; 58: 553–6.
Huang Y, Liu C, Lin J. Clinical significance of hepatic artery variations originating from the superior mesenteric artery in abdominal tumor surgery. Chin Med J (Engl) 2013; 126: 899–902.
Kleive D, Sahakyan MA, Khan A, Fosby B, Line PD, Labori KJ. Incidence and management of arterial injuries during pancreatectomy. Langenbeck’s Arch Surg 2018; 403: 341–8. https://doi.org/10.1007/s00423-018-1666-1.
Sánchez AM, Tortorelli AP, Caprino P, Rosa F, Menghi R, Quero G, et al. Incidence and Impact of Variant Celiacomesenteric Vascularization and Vascular Stenosis on Pancreatic Surgery Outcomes: Personal Experience. Am Surg 2018; 84: 181–7.
Pessaux P, Regenet N, Arnaud JP. [Resection of the retroportal pancreatic lamina during a cephalic pancreaticoduodenectomy: first dissection of the superior mesenteric artery]. Ann Chir 2003; 128: 633–6.
Rose JB, Rocha F, Alseidi A, Helton S. Posterior “superior mesenteric artery first” approach for resection of locally advanced pancreatic cancer. Ann Surg Oncol 2014; 21: 1927–8. https://doi.org/10.1245/s10434-013-3431-6.
Sanjay P, Takaori K, Govil S, Shrikhande S V, Windsor JA. {\textquoteleft}Artery-first{\textquoteright} approaches to pancreatoduodenectomy. Br J Surg 2012; 99: 1027–35. https://doi.org/10.1002/bjs.8763.
Eshuis WJ, Olde Loohuis KM, Busch ORC, van Gulik TM, Gouma DJ. Influence of aberrant right hepatic artery on perioperative course and longterm survival after pancreatoduodenectomy. HPB 2011; 13: 161–7. https://doi.org/10.1111/j.1477-2574.2010.00258.x.
Kim PTW, Temple S, Atenafu EG, Cleary SP, Moulton C-A, McGilvray ID, et al. Aberrant right hepatic artery in pancreaticoduodenectomy for adenocarcinoma: impact on resectability and postoperative outcomes. HPB (Oxford) 2014; 16: 204–11. https://doi.org/10.1111/hpb.12120.
Sulpice L, Rayar M, Paquet C, Bergeat D, Merdrignac A, Cunin D, et al. Does an aberrant right hepatic artery really influence the short- and long-term results of a pancreaticoduodenectomy for malignant disease? A matched case-controlled study. J Surg Res 2013; 185: 620–5. https://doi.org/10.1016/j.jss.2013.07.015.
Yoshida T, Matsumoto T, Morii Y, Aramaki M, Matsumoto S, Mori H, et al. Implications of arterial anatomy in patients with cancer of the periampullary region. Hepatogastroenterology n.d.; 52: 8–12.
Lai ECS. Vascular resection and reconstruction at pancreatico-duodenectomy: Technical issues. Hepatobiliary Pancreat Dis Int 2012; 11: 234–42. https://doi.org/10.1016/S1499-3872 (12) 60154-4.
Perwaiz A, Singh A, Singh T, Chaudhary A. Incidence and management of arterial anomalies in patients undergoing pancreaticoduodenectomy. JOP 2010; 11: 25–30.
Taguchi M, Sata N, Kaneda Y, Koizumi M, Hyodo M, Lefor AK, et al. Preoperative segmental embolization of the proper hepatic artery prior to pylorus-preserving pancreaticoduodenectomy: A case report. Int J Surg Case Rep 2015; 8C: 62–7. https://doi.org/10.1016/j.ijscr.2015.01.029.
Cloyd JM, Chandra V, Louie JD, Rao S, Visser BC. Preoperative embolization of replaced right hepatic artery prior to pancreaticoduodenectomy. J Surg Oncol 2012; 106: 509–12. https://doi.org/10.1002/jso.23082.
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