Aberrant peripancreatic arterial anatomy. Considerations in performing pancreatectomy for malignant neoplasms

One-hundred twenty patients with malignant neoplasms of the pancreas referred to the Surgery Branch of the National Cancer Institute over a 5-year period were prospectively examined with selective celiac and superior mesenteric angiography. Forty-one patients (34%) showed various arterial anomalies in the peripancreatic and hepatic areas. The most common anomalies included the right hepatic artery arising from the superior mesenteric artery (16%) and the left hepatic artery arising from the left gastric (11%). Thirty-two of the 120 patients eventually underwent pancreatic resection, and ten of the 32 resected patients (31%) had aberrant arterial anatomy. Recognition of the arterial anomalies permitted resection with no arterial reconstruction in nine of the patients. One patient required sacrifice of an aberrant right hepatic artery that was reconstructed with an anastomosis to the gastroduodenal artery remnant. Selective angiography should be done routinely before any potential radical resection for malignant neoplasms of the pancreas. Recognition of arterial anomalies generally permits satisfactory resection. Even if arterial segments require sacrifice, reconstruction can generally be accomplished with regional vessels, avoiding major arterial grafts.