Hepatic Artery Anomalies in Pancreaticoduodenectomy: Outcomes from a High-Volume Center

IntroductionHepatic artery anomalies (HAA) and may have an impact on surgical and oncological outcomes of patients undergoing pancreaticoduodenectomy (PD).MethodsPatients undergone PD at our Institution between July 2015 and January 2020 were retrospectively reviewed and classified into two groups: Group 1, presence of HAA and Group 2, no HAA. A weighted logistic regression model employed to assess the association between HAA and postoperative complications, and to assess the association between HAA and R status in patients with pancreatic cancer. Results502 patients were considered for analysis, with 75 (15%) of them in Group 1. They had either an accessory (aRHA, n=28, 40.8%) or replaced (rRHA, n=26, 36.6%) right hepatic artery. Most patients underwent surgery for a malignancy (n= 451; 90%); among them, vascular resection was performed in 69 cases (15%). The presence of a HAA was reported at pre-operative imaging only in 4 cases (5%)and the aberrant vessel was preserved in 72% of patients. At weighted multivariable logistic regression analysis, HAA were not associated to higher odds of morbidity (OR 0.753, 95%CI 0.543-1.043) nor to R1 status in case of pancreatic cancer (OR 1.583, 95%CI 0.979-2.561).ConclusionIn our institution the presence of HAA doesn't have an impact on post-operative outcomes nor affects oncological clearance in PD. Hospitals', surgeon's volume and systematic review of preoperative imaging are all factors that help to reduce possible adverse events.