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Introduction: Replaced or accessory right hepatic artery (RARHA) is common and may complicate pancreaticoduodenectomy.Aim: We sought to determine the impact of RARHA on postoperative morbidity, margin status, and overall survival in patients undergoing pancreaticoduodenectomy (PD) for pancreatic adenocarcinoma (PA). Methods: From 2000 to 2007, 471 consecutive patients underwent pancreaticoduodenectomy (PD) for resecttable PA at 2 institutions. Of these, 47 patients (10%) had documented RARHA. Of these, 16 patients received neoadjuvant chemoradiation (neoRARHA group) due to institutional preference and 31 patients did not receive preoperative treatment (RARHA group). Matched patients without RARHA comprised our Control group.Results: RARHA was identified by radiologists in 14 patients (29%). Conversely, surgeons identified RARHA by review of the CT scan by the operating surgeon in 24 (51%) patients preoperatively and 23 (49%) patients intraoperatively. RARHA was preserved during PD in 44 patients. Three patients with RARHA involved by PA had reconstruction (2) or ligation (1). Morbidity and mortality of the RARHA group were 36% and 2.1%, respectively. No short term or long term RARHA-related morbidity was noted. Comparison of RARHA group vs Control group revealed no significant differences in length of operation, blood loss, lymph nodes retrieved, positive lymph nodes, and involved margins. Furthermore, the neoRARHA group had lower margin positivity rate when compared to the in RARHA group, but this was not statistically significant (10% vs. 19.3%, p=0.6). All patients with R1 resection (n=8) had tumor size > 3cm. No difference was noted in median or 3-year overall survival times between RARHA group and Control group. Two patients in the RARHA group with involved RARHA died of disease progression after 6 and 12 months of follow up. One patient in the neoRARHA group with involved RARHA was still alive without recurrence after 28 month follow-up.Conclusions: PD for PA in the presence of RARHA resulted in comparable outcomes to patients without RARHA. Margin positivity was not affected by presence of RARHA, however, patients with frank RARHA involvement tended to have poorer survival. Neoadjuvant treatment should be considered in patients with RARHA involvement identified preoperatively, particularly in the subgroup with tumor size >3cm.