Does Aberrant Hepatic Arterial Anatomy Affect Resection Margin Status In Pancreaticoduodenectomy For Pancreatic Adenocarcinoma?

Abstract

Aims: Resection margin status impacts on survival after resection of pancreatic adenocarcinoma. This study aims to assess the incidence and association between aberrant hepatic arterial anatomy and resection margin status.Methodology: This is a retrospective cohort study of all patients undergoing pancreaticoduodenectomy for pancreatic adenocarcinoma between 2007 and 2012. Patient demographics, pathology data, and resection margin status (R) were analysed. Arterial anatomy based on contrast enhanced computed tomography as per Michels classification was delineated.Results: Over 5-years, 148 pancreaticoduodenectomies were performed of which 75 were for adenocarcinoma. Fifty-nine patients (78.6%) had a positive resection margin (R1). Descriptive arterial anatomy was available in 72 patients. Fifteen patients (21%) had aberrant anatomy of the hepatic artery. The presence of aberrant arterial anatomy did not have a statistically significant impact on the resection margin status (p=0.67) or involvement of the medial (p=0.34), transection (p=0.22), or posterior (p=0.062) margins. R0 resections demonstrated improved overall survival (p=0.02). Conclusion:An aberrant hepatic artery is a common finding and should be identified on pre-operative imaging. Aberrant arterial anatomy did not impact on resection margin status. There may be a trend towards posterior tumour margin involvement but this does not affect outcomes in terms of survival.