Pancreaticoduodenectomy for the Periampullary Cancers Involving an Aberrant Right Hepatic Artery

Twelve patients with aberrant right hepatic artery (ARHA) underwent pancreaticoduodenectomy for periampullary cancers. The diseases included 8 cases of pancreatic cancer, 3 cases of bile duct cancer, and 1 case of papillary cancer. We classified ARHA into the following 4 types: Type A, ARHA arising from the superior mesenteric artery (SMA); Type B, common hepatic artery arising from SMA; Type C, each right and left hepatic artery arising from celiac artery separately; Type D, ARHA arising from the gastroduodenal artery (GDA). The number of patients was 6, 1, 3 and 2, respectively. ARHA was preserved in 10 patients. However, 2 patients needed ARHA resection for curative operation. Of these 2 patients, 1 underwent arterial reconstruction and was uneventful after operation, but the other without reconstruction suffered from recurrent cholangitis. According to histopathological examinations, an R0 operation was carried out in 7 patients and a non-R0 in 5 patients. The reasons for non-R0 were dissected peripancreatic tissue margin positive (4 cases) and liver metastasis (1 case), and all non-R0 patients died of the primary disease. The preoperative imaging studies should be precisely carried out to undergo pancreatico­duodenectomy for patients with ARHA, and the detailed evaluation for ARHA types is also necessary to perform R0 operations.