Affiliation:
1. Department of Hepatobiliary Surgery, Second Affiliated Hospital of Chongqing Medical University, 76 Linjiang Road, Yuzhong District, Chongqing 400010, China
Abstract
Background: It is critical for every pancreatic surgeon to determine how to protect the aberrant hepatic artery intraoperatively in order to safely implement laparoscopic pancreatoduodenectomy (LPD). “Artery-first” approaches to LPD are ideal procedures in selected patients with pancreatic head tumors. Here, we described our surgical procedure and experience of aberrant hepatic arterial anatomy-LPD (AHAA-LPD) in a retrospective case series. In this study, we also sought to confirm the implications of the combined SMA-first approach on the perioperative and oncologic outcomes of AHAA-LPD. Methods: From January 2021 to April 2022, the authors completed a total of 106 LPDs, of which 24 patients underwent AHAA-LPD. We evaluated the courses of the hepatic artery via preoperative multi-detector computed tomography (MDCT) and classified several meaningful AHAAs. The clinical data of 106 patients who underwent AHAA-LPD and standard LPD were retrospectively analyzed. We compared the technical and oncological outcomes of the combined SMA-first approach, AHAA-LPD, and the concurrent standard LPD. Results: All the operations were successful. The combined SMA-first approaches were used by the authors to manage 24 resectable AHAA-LPD patients. The mean age of the patients was 58.1 ± 12.1 years; the mean operation time was 362 ± 60.43 min (325–510 min); blood loss was 256 ± 55.72 mL (210–350 mL); the postoperation ALT and AST were 235 ± 25.65 IU/L (184–276 IU/L) and 180 ± 34.43 IU/L (133–245 IU/L); the median postoperative length of stay was 17 days (13.0–26.0 days); the R0 resection rate was 100%. There were no cases of open conversion. The pathology showed free surgical margins. The mean number of dissected lymph nodes was 18 ± 3.5 (14–25); the number of tumor-free margins was 3.43 ± 0.78 mm (2.7–4.3 mm). There were no Clavien–Dindo III–IV classifications or C-grade pancreatic fistulas. The number of lymph node resections was greater in the AHAA-LPD group (18 vs. 15, p < 0.001). Surgical variables (OT) or postoperative complications (POPF, DGE, BL, and PH) showed no significant statistical differences in both groups. Conclusions: In performing AHAA-LPD, the combined SMA-first approach for the periadventitial dissection of the distinct aberrant hepatic artery to avoid hepatic artery injury is feasible and safe when performed by a team experienced in minimally invasive pancreatic surgery. The safety and efficacy of this technique need to be confirmed in large-scale-sized, multicenter, prospective randomized controlled studies in the future.
Funder
National Natural Science Foundation of China
Chongqing Natural Science Foundation
General Program of Chongqing Natural Science Foundation
Reference34 articles.
1. Anatomic variations of hepatic artery and new clinical classification based on abdominal angiographic images of 1200 cases;Kobayashi;Hepatogastroenterology,2014
2. Eleven cases of postoperative hepatic infarction following pancreato-biliary surgery;Miura;J. Gastrointest. Surg.,2010
3. Hepatic infarction secondary to arterial insufficiency in native livers: CT findings in 10 patients;Smith;Radiology,1998
4. Hepatic infarction following abdominal interventional procedures;Fujiwara;Acta Med. Okayama,2004
5. Pancreaticoduodenectomy. The importance of preserving hepatic blood flow to prevent biliary fistula;Traverso;Am. Surg.,1989
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