Implications of Arterial Variations in Pancreatoduodenectomy for Cancer
Journal of Surgery
Volume 8, Issue 1, February 2020, Pages: 5-8
Received: Nov. 10, 2019; Accepted: Jan. 2, 2020; Published: Jan. 17, 2020
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Authors
Silvio Marcio Pegoraro Balzan, Department of Biology and Pharmacy (Liga Acadêmica do Cancer), University of Santa Cruz do Sul (UNISC), Santa Cruz do Sul, Brazil; Saint Gallen Institute of Oncology, Santa Cruz do Sul, Brazil; Oncology Center Lydia Wong Ling (Moinhos de Vento Hospital), Porto Alegre, Brazil
Vinicius Grando Gava, Oncology Center Lydia Wong Ling (Moinhos de Vento Hospital), Porto Alegre, Brazil
Érika Luiza Maschio, Department of Biology and Pharmacy (Liga Acadêmica do Cancer), University of Santa Cruz do Sul (UNISC), Santa Cruz do Sul, Brazil
Victoria Lucateli Bernardi, Department of Biology and Pharmacy (Liga Acadêmica do Cancer), University of Santa Cruz do Sul (UNISC), Santa Cruz do Sul, Brazil
Giana da Silva Lima, Department of Biology and Pharmacy (Liga Acadêmica do Cancer), University of Santa Cruz do Sul (UNISC), Santa Cruz do Sul, Brazil
Graziela de Gasperi, Department of Biology and Pharmacy (Liga Acadêmica do Cancer), University of Santa Cruz do Sul (UNISC), Santa Cruz do Sul, Brazil
Morgana Pizzolatti Marins, Department of Biology and Pharmacy (Liga Acadêmica do Cancer), University of Santa Cruz do Sul (UNISC), Santa Cruz do Sul, Brazil
Vanessa Batistella Kunzler, Department of Biology and Pharmacy (Liga Acadêmica do Cancer), University of Santa Cruz do Sul (UNISC), Santa Cruz do Sul, Brazil
Bruna Aparecida Fontana Costa, Department of Biology and Pharmacy (Liga Acadêmica do Cancer), University of Santa Cruz do Sul (UNISC), Santa Cruz do Sul, Brazil
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Abstract
Pancreatoduodenectomy for cancer is a complex surgical procedure with significant morbidity and mortality. Technical aspects of this procedure typically comprise dissection of celiac trunk, the common and the proper hepatic arteries. The presence of hepatic arterial anomalies is not uncommon and influences surgical technique. An aberrant right hepatic artery (replaced or accessory) or a common hepatic artery originating from the superior mesenteric artery are present in nearly 13% of cases and usually run in contact with the posterior aspect of the head of the pancreas. These anomalous arteries are at risk of iatrogenic injury and tumor involvement. Iatrogenic vascular lesions can lead to bleeding and/or ischemic complications, such as anastomotic stenosis, hepatic abscess and liver failure. Also, vascular tumor involvement might require arterial resection and reconstruction. The presence of arterial variations should not affect the radicalness of pancreatic resection as the involvement of aberrant arteries does not seem to affect postoperative outcomes or overall survival. These vascular variations should be, preferably, recognized pre-operatively in order to define possible surgical strategies. Preoperative contrast enhanced computed tomography provides accurate arterial anatomy evaluation. Lastly, aberrant hepatic arteries require proper dissection and/or occasionally resection and reconstruction during pancreatoduodenectomy to achieve a safe resection with proper radicalness. Knowledge of arterial variations is crucial for pancreatic cancer surgery.
Keywords
Pancreatic Cancer, Pancreatoduodenectomy, Arterial Variations, Pancreatic Surgery
To cite this article
Silvio Marcio Pegoraro Balzan, Vinicius Grando Gava, Érika Luiza Maschio, Victoria Lucateli Bernardi, Giana da Silva Lima, Graziela de Gasperi, Morgana Pizzolatti Marins, Vanessa Batistella Kunzler, Bruna Aparecida Fontana Costa, Implications of Arterial Variations in Pancreatoduodenectomy for Cancer, Journal of Surgery. Vol. 8, No. 1, 2020, pp. 5-8. doi: 10.11648/j.js.20200801.12
Copyright
Copyright © 2020 Authors retain the copyright of this article.
This article is an open access article distributed under the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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