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.
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.
Authors: Helmut Oettle; Stefan Post; Peter Neuhaus; Klaus Gellert; Jan Langrehr; Karsten Ridwelski; Harald Schramm; Joerg Fahlke; Carl Zuelke; Christof Burkart; Klaus Gutberlet; Erika Kettner; Harald Schmalenberg; Karin Weigang-Koehler; Wolf-Otto Bechstein; Marco Niedergethmann; Ingo Schmidt-Wolf; Lars Roll; Bernd Doerken; Hanno Riess Journal: JAMA Date: 2007-01-17 Impact factor: 56.272
Authors: Corinne B Winston; Nancy A Lee; William R Jarnagin; Jerrold Teitcher; Ronald P DeMatteo; Yuman Fong; Leslie H Blumgart Journal: AJR Am J Roentgenol Date: 2007-07 Impact factor: 3.959
Authors: Irene Esposito; Jörg Kleeff; Frank Bergmann; Caroline Reiser; Esther Herpel; Helmut Friess; Peter Schirmacher; Markus W Büchler Journal: Ann Surg Oncol Date: 2008-03-20 Impact factor: 5.344
Authors: Mark P Callery; Kenneth J Chang; Elliot K Fishman; Mark S Talamonti; L William Traverso; David C Linehan Journal: Ann Surg Oncol Date: 2009-04-24 Impact factor: 5.344
Authors: Thierry Conroy; Françoise Desseigne; Marc Ychou; Olivier Bouché; Rosine Guimbaud; Yves Bécouarn; Antoine Adenis; Jean-Luc Raoul; Sophie Gourgou-Bourgade; Christelle de la Fouchardière; Jaafar Bennouna; Jean-Baptiste Bachet; Faiza Khemissa-Akouz; Denis Péré-Vergé; Catherine Delbaldo; Eric Assenat; Bruno Chauffert; Pierre Michel; Christine Montoto-Grillot; Michel Ducreux Journal: N Engl J Med Date: 2011-05-12 Impact factor: 91.245
Authors: Olivıer Turrini; Eric A Wiebke; Jean Robert Delpero; Frédéric Viret; Keith D Lillemoe; C Max Schmidt Journal: J Gastrointest Surg Date: 2010-08-10 Impact factor: 3.452
Authors: Ioannis T Konstantinidis; Andrew L Warshaw; Jill N Allen; Lawrence S Blaszkowsky; Carlos Fernandez-Del Castillo; Vikram Deshpande; Theodore S Hong; Eunice L Kwak; Gregory Y Lauwers; David P Ryan; Jennifer A Wargo; Keith D Lillemoe; Cristina R Ferrone Journal: Ann Surg Date: 2013-04 Impact factor: 12.969
Authors: Ji Hun Kim; Raquel Gonzalez-Heredia; Despoina Daskalaki; Mohammad Rashdan; Mario Masrur; Pier C Giulianotti Journal: HPB (Oxford) Date: 2016-05-20 Impact factor: 3.647