Review Article
Management of the right hepatic artery in pancreaticoduodenectomy: a systematic review
Abstract
Introduction: The right hepatic artery (RHA) is the most common hepatic artery (CHA) variation. This variation may be problematic in pancreaticoduodenectomy (PD). We aimed to evaluate the impact of the RHA on postoperative and oncological outcomes.
Methods and materials: The PubMed database was systematically searched for comparative studies reporting management of the RHA during PD for the years 1950-2014.
Results: A total of 2,278 patients were analyzed, of whom 440 (19%) had a RHA. The most CHA variation was a replaced RHA. The conservative approach was the most frequently adopted (87%) and only 8% of patients had a sacrifice without reconstruction of the RHA. Postoperative mortality and overall morbidity were similar between patients with and without RHA. Despite the preservation of the RHA in most cases, the rates of microscopic positive margin were also comparable between two groups with no impact of RHA on survival rates.
Conclusions: Postoperative and oncological outcomes seemed unaffected by the RHA in PD. Prospective studies are needed to evaluate its oncological impact.
Methods and materials: The PubMed database was systematically searched for comparative studies reporting management of the RHA during PD for the years 1950-2014.
Results: A total of 2,278 patients were analyzed, of whom 440 (19%) had a RHA. The most CHA variation was a replaced RHA. The conservative approach was the most frequently adopted (87%) and only 8% of patients had a sacrifice without reconstruction of the RHA. Postoperative mortality and overall morbidity were similar between patients with and without RHA. Despite the preservation of the RHA in most cases, the rates of microscopic positive margin were also comparable between two groups with no impact of RHA on survival rates.
Conclusions: Postoperative and oncological outcomes seemed unaffected by the RHA in PD. Prospective studies are needed to evaluate its oncological impact.
