CONTEXT: Pancreaticoduodenectomy entails ligation of vascular arcades arising from the celiac and superior mesenteric arteries. These are known to have anatomical variations. OBJECTIVE: This study was aimed at analyzing the spectrum of arterial anomalies and their clinical impact on the procedure itself. PATIENTS: The study includes 200 consecutive patients who underwent a pancreaticoduodenectomy between September 2003 and May 2009 after excluding those having distant metastases or local unresectability. MAIN OUTCOME MEASURES: The records of the patients were studied to assess the incidence of arterial anomalies and the operative complexities involved in a pancreaticoduodenectomy. RESULTS: Fifty-three patients (26.5%) had arterial anomalies. The complexity of the surgery was determined by the course of these arteries. The mean duration of surgery was 420 + or - 32.0 minutes in patients with arterial anomalies versus 370 + or - 38.5 minutes in those with a normal arterial anatomy (P=0.005). Fifty-one out of 53 (96.2%) patients underwent pancreaticoduodenectomy with negative resection margins. The pancreaticoduodenectomy was abandoned in two cases due to patient- and tumor-related factors. CONCLUSION: During pancreaticoduodenectomy, arterial anomalies can increase operative complexity but do not usually compromise the safety of the procedure or its oncological outcome.
CONTEXT: Pancreaticoduodenectomy entails ligation of vascular arcades arising from the celiac and superior mesenteric arteries. These are known to have anatomical variations. OBJECTIVE: This study was aimed at analyzing the spectrum of arterial anomalies and their clinical impact on the procedure itself. PATIENTS: The study includes 200 consecutive patients who underwent a pancreaticoduodenectomy between September 2003 and May 2009 after excluding those having distant metastases or local unresectability. MAIN OUTCOME MEASURES: The records of the patients were studied to assess the incidence of arterial anomalies and the operative complexities involved in a pancreaticoduodenectomy. RESULTS: Fifty-three patients (26.5%) had arterial anomalies. The complexity of the surgery was determined by the course of these arteries. The mean duration of surgery was 420 + or - 32.0 minutes in patients with arterial anomalies versus 370 + or - 38.5 minutes in those with a normal arterial anatomy (P=0.005). Fifty-one out of 53 (96.2%) patients underwent pancreaticoduodenectomy with negative resection margins. The pancreaticoduodenectomy was abandoned in two cases due to patient- and tumor-related factors. CONCLUSION: During pancreaticoduodenectomy, arterial anomalies can increase operative complexity but do not usually compromise the safety of the procedure or its oncological outcome.