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01-01-2015 | Original Article

A replaced right hepatic artery adjacent to pancreatic carcinoma should be divided to obtain R0 resection in pancreaticoduodenectomy

Authors: Ken-ichi Okada, Manabu Kawai, Seiko Hirono, Motoki Miyazawa, Atsushi Shimizu, Yuji Kitahata, Masaji Tani, Hiroki Yamaue

Published in: Langenbeck's Archives of Surgery | Issue 1/2015

Abstract

Background

The aim of the present study was to clarify the optimal surgical strategy in the patients with right hepatic artery (RHA) variation undergoing pancreaticoduodenectomy (PD) based on the tumor position and the R1 resection rate.

Methods

A total of 180 consecutive patients who underwent PD for pancreatic ductal adenocarcinoma between January 2000 and May 2013 were evaluated for RHA variation, surgical outcome, and the R1 resection rate retrospectively. In this study, we defined three types of tumors: (i) the resectable type, where tumors were situated more than 10 mm away from the root of the replaced right hepatic artery (rRHA)/replaced common hepatic artery (rCHA); (ii) the adjacent type, where tumors were situated within 10 mm from the root of the rRHA/rCHA without tumor abutment of the superior mesenteric artery (SMA); and (iii) the borderline resectable type, where the tumor abuts the SMA, but does not to exceed 180° of the circumference of the vessel wall.

Results

Twenty-five patients were identified to have a RHA variation in preoperative imaging studies. There were 16 patients with resectable type tumors, five with adjacent type tumors, and four with borderline resectable tumors. The rRHA/rCHA was preserved in 14 (88 %) patients with the resectable type, all of the patients with the adjacent type and none of the patients with the borderline type pancreatic carcinomas. The R1 resection rates were significantly higher in patients with adjacent/borderline resectable type tumors (78 %) compared to those with resectable type tumors (6 %) (p = 0.001).

Conclusion

The rRHA of the adjacent type pancreatic carcinoma should be divided to improve the rate of R0 resection.

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Title: A replaced right hepatic artery adjacent to pancreatic carcinoma should be divided to obtain R0 resection in pancreaticoduodenectomy
Authors: Ken-ichi Okada
Manabu Kawai
Seiko Hirono
Motoki Miyazawa
Atsushi Shimizu
Yuji Kitahata
Masaji Tani
Hiroki Yamaue
Publication date: 01-01-2015
Publisher: Springer Berlin Heidelberg
Published in: Langenbeck's Archives of Surgery / Issue 1/2015
Print ISSN: 1435-2443
Electronic ISSN: 1435-2451
DOI: https://doi.org/10.1007/s00423-014-1255-x

Keynote webinar | Spotlight on medication adherence

Springer Medicine

A replaced right hepatic artery adjacent to pancreatic carcinoma should be divided to obtain R0 resection in pancreaticoduodenectomy

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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