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The Preservation of Replaced Right Hepatic Artery Adjacent to Pancreatic Carcinoma Correlates High R1 Resection Rate in Pancreaticoduodenectomy
Ken-Ichi Okada*, Manabu Kawai, Seiko Hirono, Motoki Miyazawa, Atsushi Shimizu, Yuji Kitahata, Hiroki Yamaue
Wakayama Medical University Hospital, Wakayama, Japan
Background/Purpose. Resectable/borderline resectable category at increased risk of higher likelihood of an R1 resection in patients with right hepatic artery (RHA) variation has not been well discussed. The aim of the present study was to clarify the strategy in the patients with RHA variation undergoing pancreaticoduodenectomy (PD) based on the tumor position and R1 resection rate.
Methods. The medical records of 180 consecutive patients who underwent PD for pancreatic ductal adenocarcinoma between January 2000 and May 2013 were evaluated for the R1 resection rate, surgical outcome, and survival. In this study, three types were defined as (i) resectable type, tumors situated more than 10 mm away from the root of replaced right hepatic artery (rRHA)/replaced common hepatic artery (rCHA), (ii) adjacent type, tumors situated within 10mm from the root of rRHA/rCHA without tumor abutment of the SMA, and, (iii) borderline resectable type, the patients with tumor abutment of the SMA not to exceed 180° of the circumference of the vessel wall, were classified.
Results. In the present study, 25 patients were identified to have RHA variation in preoperative imaging study. There were sixteen patients with resectable type, 5 with adjacent type, and 4 with borderline resectable type; the R1 resection rates revealed 6% (n=1), 80% (n=4), and 75% (n=3) respectively. rRHA/rCHA were preserved in 14 (88%) patients with resectable type, all of adjacent type, and none of borderline type pancreatic carcinoma. In resectable/adjacent type cases, all positive margins were identified in the retropancreatic tissue adjacent to the periarterial nerve plexuses around the aRHA/aCHA.
Conclusion. The strategy to resect rRHA of the adjacent type pancreatic carcinoma would improve the R0 resection rate.
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