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Malviya KK, Verma A. Importance of Anatomical Variation of the Hepatic Artery for Complicated Liver and Pancreatic Surgeries: A Review Emphasizing Origin and Branching. Diagnostics (Basel) 2023; 13:diagnostics13071233. [PMID: 37046451 PMCID: PMC10093498 DOI: 10.3390/diagnostics13071233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 03/21/2023] [Accepted: 03/22/2023] [Indexed: 04/14/2023] Open
Abstract
Knowledge of anatomical variations of the hepatic artery from its origin to intrahepatic segmentation is of utmost importance for planning upper abdominal surgeries including liver transplantation, pancreatoduodenectomy, and biliary reconstruction. The origin and branching pattern of the hepatic artery was thoroughly described by the classification of Michels and Hiatt. Some rare variations of the hepatic artery were classified by Kobayashi and Koops. By the use of the multidetector computed tomography (MDCT) technique, the branching pattern of the hepatic artery can be visualized quite accurately. Unawareness of these arterial variations may lead to intraoperative injuries such as necrosis, abscess, and failure of the liver and pancreas. The origin and course of the aberrant hepatic arteries are crucial in the surgical planning of carcinoma of the head of the pancreas and hepatobiliary surgeries. In liver transplant surgeries, to minimize intraoperative bleeding complications and postoperative thrombosis, exact anatomy of the branching of the hepatic artery, its variations and intrahepatic course is of utmost importance. This review discusses variations in the anatomy of the hepatic artery from its origin to branching by the use of advanced imaging techniques and its effect on the liver, pancreatic, biliary and gastric surgeries.
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Affiliation(s)
- Kapil Kumar Malviya
- Department of Anatomy, Institute of Medical Science, Banaras Hindu University, Varanasi 221005, Uttar Pradesh, India
| | - Ashish Verma
- Department of Radiodiagnosis and Imaging, Institute of Medical Science, Banaras Hindu University, Varanasi 221005, Uttar Pradesh, India
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Pravisani R, Sepulveda A, Cocchi L, de Mello E, Cauchy F, Dokmak S, Farges O, Durand F, Weiss E, Dondero F, Lesurtel M. Graft aberrant hepatic arteries in deceased donor liver transplantation: The "one liver, one artery" approach. Liver Transpl 2022; 28:1876-1887. [PMID: 35751148 DOI: 10.1002/lt.26536] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 05/16/2022] [Accepted: 06/07/2022] [Indexed: 01/13/2023]
Abstract
In liver transplantation (LT), graft aberrant hepatic arteries (aHAs) frequently require complex arterial reconstructions, potentially increasing the risk of post-operative complications. However, intrahepatic hilar arterial shunts are physiologically present and may allow selective aHA ligation. Thus, we performed a retrospective study from a single-center cohort of 618 deceased donor LTs where a selective reconstruction policy of aHAs was prospectively applied. In the presence of any aHA, the vessel with the largest caliber was first reconstructed. In case of adequate bilobar arterial perfusion assessed on intraparenchymal Doppler ultrasound, the remnant vessel was ligated; otherwise, it was reconstructed. Consequently, outcomes of three patient groups were compared: the "no aHAs" group (n = 499), the "reconstructed aHA" group (n = 25), and the "ligated aHA" group (n = 94). Primary endpoint was rate of biliary complications. Only 38.4% of right aHAs and 3.1% of left aHAs were reconstructed. Rates of biliary complications in the no aHA, reconstructed aHA, and ligated aHA groups were 23.4%, 28%, and 20.2% (p = 0.667), respectively. The prevalence rates of primary non-function (p = 0.534), early allograft dysfunction (p = 0.832), and arterial complications (p = 0.271), as well as patient survival (p = 0.266) were comparable among the three groups. Retransplantation rates were 3.8%, 4%, and 5.3% (p = 0.685), respectively. In conclusion, a selective reconstruction policy of aHAs based on Doppler assessment of bilobar intraparenchymal arterial flow did not increase post-operative morbidity and avoided unnecessary and complex arterial reconstructions.
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Affiliation(s)
- Riccardo Pravisani
- Department of HPB Surgery and Liver Transplantation, AP-HP Beaujon HospitalUniversity of ParisClichyFrance
- Liver-Kidney Transplant Unit, Department of MedicineUniversity of UdineUdineItaly
| | - Ailton Sepulveda
- Department of HPB Surgery and Liver Transplantation, AP-HP Beaujon HospitalUniversity of ParisClichyFrance
| | - Lorenzo Cocchi
- Department of HPB Surgery and Liver Transplantation, AP-HP Beaujon HospitalUniversity of ParisClichyFrance
| | - Estrella de Mello
- Department of HPB Surgery and Liver Transplantation, AP-HP Beaujon HospitalUniversity of ParisClichyFrance
| | - Francois Cauchy
- Department of HPB Surgery and Liver Transplantation, AP-HP Beaujon HospitalUniversity of ParisClichyFrance
| | - Safi Dokmak
- Department of HPB Surgery and Liver Transplantation, AP-HP Beaujon HospitalUniversity of ParisClichyFrance
| | - Olivier Farges
- Department of HPB Surgery and Liver Transplantation, AP-HP Beaujon HospitalUniversity of ParisClichyFrance
| | - Francois Durand
- Hepatology and Liver Intensive Care, AP-HP Beaujon HospitalUniversity of ParisClichyFrance
| | - Emmanuel Weiss
- Department of Anesthesiology and Critical Care, AP-HP Beaujon HospitalUniversity of ParisClichyFrance
| | - Federica Dondero
- Department of HPB Surgery and Liver Transplantation, AP-HP Beaujon HospitalUniversity of ParisClichyFrance
| | - Mickaël Lesurtel
- Department of HPB Surgery and Liver Transplantation, AP-HP Beaujon HospitalUniversity of ParisClichyFrance
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Rajapriyan P, Dutta S, Nagarajan K, Ariharan K, Ramakrishnaiah VPN. Prevalence of hepatic vascular anomalies in consecutive contrast-enhanced computed tomography images — a retrospective observational study. EGYPTIAN LIVER JOURNAL 2022. [DOI: 10.1186/s43066-022-00225-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Background
Liver is a complex, highly vascular organ, where anatomical variations are the norm. This study aimed to analyze all the three hepatic vascular anatomical variations in a single study which would help us understand the prevalence of hepatic vascular (arterial, portal, venous) anomalies in the population catered to by our institution.
Methods
A retrospective analysis of 545 contrast-enhanced CT scans was done from November 2019 from the institute PACS after satisfying the inclusion and exclusion criteria. The raw imaging data were processed in PACS software — Centricity™ Universal Viewer and Syngo.via Vb20 platform, for axial, coronal, and axial-oblique multiplanar reformation, maximum intensity projection (MIP), and volume rendering (VR) images. Data were analyzed in the three vascular phases to determine the anatomical variations. Analysis was done by two surgical residents in the division of HPB surgery, which was verified by a certified radiologist.
Results
There were no major differences in the prevalence rates of the vascular anomalies across gender and domicile distributions. The prevalence of normal hepatic artery and variant hepatic artery in our study was 69% and 31%, respectively. Accessory left hepatic artery (10%) was the most common hepatic artery variant in our study. Single RHV was seen in 77.4%, and other RHV variants like two RHV with common trunk, two RHV with independent drainage, and three RHV with common trunk contribute 22.6% of our study population. Accessory inferior RHV was seen in 19.8% of the study population. Normal portal vein anatomy was found in 81.1% in our study, and the most common variant in our study population was trifurcation of portal vein (16.1%).
Conclusion
This was the largest study until date from South India, studying all three hepatic vascular anatomical variations in a single study. Variations in the anatomy of hepatic arteries, portal veins, and hepatic veins are common. A good knowledge of the same is necessary especially for a hepatobiliary surgeon or for an interventional radiologist, to plan and avoid complications during a procedure. Preoperative contrast-enhanced CT scan and whenever necessary a VR or a MIP reconstruction will precisely help in identifying these variations.
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Yan Y, Wang B, Yuan W, Zhang J, Xiao J, Sha Y. A rare case with multiple arterial variations of the liver complicated laparoscopic pancreaticoduodenectomy. BMC Gastroenterol 2022; 22:331. [PMID: 35799108 PMCID: PMC9260989 DOI: 10.1186/s12876-022-02398-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 06/22/2022] [Indexed: 11/17/2022] Open
Abstract
Background Hepatic arterial variations were fully elaborated in anatomical monographs. Here, we aimed to present a rare case with multiple arterial variations of the liver complicated laparoscopic pancreaticoduodenectomy. Case presentation We report a 67-year-old woman with a periampullary tumor underwent laparoscopic pancreaticoduodenectomy. Intraoperatively, the aberrant right hepatic artery derived from the gastroduodenal artery (GDA) was observed and had accidentally sacrificed due to untimely ligature of GDA. Three-dimensional reconstruction based on preoperative contrast-enhanced CT performed to better study the anatomy. It demonstrated a replaced right hepatic artery branched from the GDA and supplied right liver lobe. Meanwhile, the middle hepatic artery derived from the common hepatic artery and supplied hepatic segment IV. Additionally, the replaced left hepatic artery emerged from the left gastric artery and fed into left liver lobe. Conclusions The origination and course of hepatic arterial anatomy should be thoroughly assessed in planning and performing hepatopancreatobiliary surgeries. Reconstruction images of contrast-enhanced CT are helpful to visualize the vascular variations and its spatial relation with adjacent structures.
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Affiliation(s)
- Yong Yan
- Department of General Surgery, Guangzhou Red Cross Hospital, Jinan University, Guangzhou, 510220, China.
| | - Bailin Wang
- Department of General Surgery, Guangzhou Red Cross Hospital, Jinan University, Guangzhou, 510220, China
| | - Wei Yuan
- Department of General Surgery, Guangzhou Red Cross Hospital, Jinan University, Guangzhou, 510220, China
| | - Jiansong Zhang
- The Medical College of Guizhou Medical University, Guiyang, 550025, China
| | - Junhao Xiao
- The Medical College of Guizhou Medical University, Guiyang, 550025, China
| | - Yanhua Sha
- Department of Laboratory Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510120, China.
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Mishra AK, Sah B, Yadav R, Shrestha A, Bhattarai A, Ranjit N, Gautam J, Bhandari R, Dhungel D, Adhikari B. Five vascular variations in a male cadaver: An anatomical case report. TRANSLATIONAL RESEARCH IN ANATOMY 2022. [DOI: 10.1016/j.tria.2022.100208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Tao W, Peng D, Cheng YX, Zhang W. Clinical significance of aberrant left hepatic artery during gastrectomy: A systematic review. World J Clin Cases 2022; 10:3121-3130. [PMID: 35647120 PMCID: PMC9082717 DOI: 10.12998/wjcc.v10.i10.3121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 12/12/2021] [Accepted: 02/20/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Vascular variations are frequently encountered during surgery. Approximately thirty percent of these variations are aberrant left hepatic arteries originating from the left gastric artery.
AIM To summarize the safety and feasibility of aberrant left hepatic arteries (ALHA) ligation in gastric cancer patients who underwent laparoscopic-assisted gastrectomy (LAG).
METHODS The literature search was systematically performed on databases including PubMed, Embase, and Cochrane Library. The publishing date of eligible studies was from inception to June 2021.
RESULTS A total of nine studies were included according to the inclusion and exclusion criteria in this review. The variation rate of ALHA ranged from 7.00% to 20.70%, and four studies compared the differences between the ALHA ligation group and the preservation group. Only one study showed worse postoperative outcomes in the ALHA ligation group. In all the included studies, a significant difference was found between the ALHA ligation group and the preservation group in terms of postoperative liver enzymes after LAG. However, there was no significant difference in the number of retrieved lymph nodes between the two groups.
CONCLUSION In conclusion, it is not always safe and feasible for surgeons to ligate the ALHA during LAG surgery, and it is necessary for gastric cancer patients to undergo preoperative examination to clarify the ALHA subtypes, measure the diameter of the ALHA, and determine whether the patients have chronic liver disease.
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Affiliation(s)
- Wei Tao
- Department of Gastrointestinal Surgery, the First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Dong Peng
- Department of Gastrointestinal Surgery, the First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Yu-Xi Cheng
- Department of Gastrointestinal Surgery, the First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Wei Zhang
- Department of Gastrointestinal Surgery, the First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
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Balcerzak A, Tubbs RS, Waśniewska-Włodarczyk A, Olewnik Ł. Classification of the Superior Mesenteric Artery. Clin Anat 2022; 35:501-511. [PMID: 35088464 DOI: 10.1002/ca.23841] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 01/25/2022] [Accepted: 01/25/2022] [Indexed: 11/06/2022]
Abstract
The aim of this study was to characterize the branching pattern and morphology of the superior mesenteric artery (SMA), and also to create a new SMA classification, which seems necessary for clinicians performing surgery in this anatomical area. The anatomical variations in the branching patterns of the SMA were examined in 30 cadavers fixed in 10% formalin. Morphometric measurements were then obtained twice by two researchers. In the proposed classification system, Type I, characterized by all normal branches - inferior pancreatoduodenal artery, ileocolic artery, right colic artery, middle colic artery and intestinal arteries - occurred in 53.33% of the specimens. Type II, characterized by absence of the inferior pancreatoduodenal artery, was present in 26.67%. Type III, characterized by absence of the right colic artery, was present in 3.33%. Type IV, characterized by a common trunk for the inferior pancreatoduodenal artery and middle colic arteries, was observed in 3.33%. Type V, characterized by an aberrant hepatic artery and absence of the inferior pancreatoduodenal artery, was observed in 13.33%. The origin of the SMA was at the Th12/L1 level in 10% of cases, at L1 in 43.33%, at L1/L2 in 36.67%, and at L2 in 10%. The SMA is characterized by high morphological variability, the variants being associated with distinct clinical aspects. The introduction of a new, structured, anatomical classification seems necessary for all clinicians.
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Affiliation(s)
- Adrian Balcerzak
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Poland
| | - R Shane Tubbs
- Department of Neurosurgery, Tulane University School of Medicine, New Orleans, Louisiana, USA.,Department of Neurology, Tulane University School of Medicine, New Orleans, Louisiana, USA.,Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana, USA.,Department of Structural & Cellular Biology, Tulane University School of Medicine, New Orleans, Louisiana, USA.,Department of Neurosurgery and Ochsner Neuroscience Institute, Ochsner Health System, New Orleans, Louisiana, USA.,Department of Anatomical Sciences, St. George's University, Grenada
| | | | - Łukasz Olewnik
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Poland
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Malviya KK, Verma A, Nayak AK, Mishra A, More RS. Unraveling Variations in Celiac Trunk and Hepatic Artery by CT Angiography to Aid in Surgeries of Upper Abdominal Region. Diagnostics (Basel) 2021; 11:2262. [PMID: 34943499 PMCID: PMC8700197 DOI: 10.3390/diagnostics11122262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Revised: 11/24/2021] [Accepted: 11/27/2021] [Indexed: 11/26/2022] Open
Abstract
Understanding of variations in the course and source of abdominal arteries is crucial for any surgical intervention in the peritoneal space. Intricate surgeries of the upper abdominal region, such as hepato-biliary, pancreatic, gastric and splenic surgeries, require precise knowledge of regular anatomy and different variations related to celiac trunk and hepatic artery. In addition, information about the origin of inferior phrenic artery is important in conditions such as hepatocellular carcinoma and gastroesophageal bleeding management. The present study gives an account of anatomical variations in origin and branching pattern of celiac trunk and hepatic artery by the use of CT (computed tomographic) angiography. The study was performed on 110 (66 females and 44 males) patients in a north Indian population. Results unraveled the most common celiac trunk variation as hepatosplenic trunk with left gastric artery, which was observed in 60% of cases, more common in females than in males. Gastrosplenic and hepato-gastric trunk could be seen in 4.55% and 1.82% cases respectively. Gastrosplenic trunk was more commonly found in females, whereas hepato-gastric trunk was more common in males. A gastrosplenic trunk, along with the hepato-mesenteric trunk, was observed in 1.82% cases and was more common in males. A celiacomesenteric trunk, in which the celiac trunk and superior mesenteric artery originated as a common trunk from the aorta, was seen only in 0.91% of cases, and exhibited an origin of right and left inferior phrenic artery from the left gastric artery. The most common variation of hepatic artery, in which the right hepatic artery was replaced and originated from the superior mesenteric artery, was observed in 3.64%, cases with a more common occurrence in males. In 1.82% cases, the left hepatic artery was replaced and originated from the left gastric artery, which was observed only in females. Common hepatic artery originated from the superior mesenteric artery, as observed in 1.82% cases, with slightly higher occurrence in males. These findings not only add to the existing knowledge apart from giving an overview of variations in north Indian population, but also give an account of their correlation with gender. The present study will prove to be important for various surgeries of the upper abdominal region.
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Affiliation(s)
- Kapil Kumar Malviya
- Department of Anatomy, Institute of Medical Science, Banaras Hindu University, Varanasi 221005, India; (A.K.N.); (A.M.); (R.S.M.)
| | - Ashish Verma
- Department of Radiodiagnosis and Imaging, Institute of Medical Science, Banaras Hindu University, Varanasi 221005, India;
| | - Amit Kumar Nayak
- Department of Anatomy, Institute of Medical Science, Banaras Hindu University, Varanasi 221005, India; (A.K.N.); (A.M.); (R.S.M.)
| | - Anand Mishra
- Department of Anatomy, Institute of Medical Science, Banaras Hindu University, Varanasi 221005, India; (A.K.N.); (A.M.); (R.S.M.)
| | - Raghunath Shahaji More
- Department of Anatomy, Institute of Medical Science, Banaras Hindu University, Varanasi 221005, India; (A.K.N.); (A.M.); (R.S.M.)
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Xie F, Wang J, Yang Q. Recurrent pyogenic liver abscess after pancreatoduodenectomy caused by common hepatic artery injury: A case report. World J Clin Cases 2021; 9:9198-9204. [PMID: 34786405 PMCID: PMC8567520 DOI: 10.12998/wjcc.v9.i30.9198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 05/28/2021] [Accepted: 09/08/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Pancreaticoduodenectomy (PD) has been increasingly performed as a safe treatment option for periampullary malignant and benign disorders. However, the operation may result in significant postoperative complications. Here, we present a case that recurrent pyogenic liver abscess after PD is caused by common hepatic artery injury in atypical celiac axis anatomy.
CASE SUMMARY A 56-year-old man with a 1-d history of fever and shivering was diagnosed with hepatic abscess. One year and five months ago, he underwent PD at a local hospital to treat chronic pancreatitis. After the operation, the patient had recurrent intrahepatic abscesses for 4 times, and the symptoms were relieved after percutaneous transhepatic cholangial drainage combining with anti-inflammatory therapy in the local hospital. Further examination showed that the recurrent liver abscess after PD was caused by common hepatic artery injury due to abnormal abdominal vascular anatomy. The patient underwent percutaneous drainage but continued to have recurrent episodes. His condition was eventually cured by right hepatectomy. In this case, preoperative examination of the patient’s anatomical variations with computed tomography would have played a pivotal role in avoiding arterial injuries.
CONCLUSION A careful computed tomography analysis should be considered mandatory not only to define the operability (with radical intent) of PD candidates but also to identify atypical arterial patterns and plan the optimal surgical strategy.
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Affiliation(s)
- Fei Xie
- Department of Hepatobiliary Surgery, The First People's Hospital of Neijiang, Neijiang 641000, Sichuan Province, China
| | - Jie Wang
- Department of Hepatobiliary Surgery, The First People's Hospital of Neijiang, Neijiang 641000, Sichuan Province, China
| | - Qin Yang
- Department of Gastroenterology, The First People's Hospital of Neijiang, Neijiang 641000, Sichuan Province, China
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Dilek ON, Atay A. Dealing with hepatic artery traumas: A clinical literature review. World J Clin Cases 2021; 9:8425-8440. [PMID: 34754851 PMCID: PMC8554434 DOI: 10.12998/wjcc.v9.i28.8425] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 04/05/2021] [Accepted: 08/11/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The hepatic artery (HA) is one of the most threatened vascular structures during hepatopancreatobiliary (HPB) surgeries and interventional procedures. It can be affected by many clinical pictures, especially tumors, due to its anatomical position and neighborhood.
AIM To reveal the evolution and recent developments in the management of HA traumas in the light of the literature.
METHODS In this article, 100 years of MEDLINE (PubMed) literature and articles including cases and series of HA injuries were reviewed, and the types of injury occurrence, treatment, and related complications and their management were compiled.
RESULTS The risk of HA injury increases during cholecystectomies and pancreatoduodenectomies, among the most common operations. HA anatomy shows anomalies in approximately 15%-25% of the cases, further increasing this risk. The incidence of HA injury is not precisely known. Approaches that have evolved in recent years in managing patients with HA injury (laceration, transection, ligation, resection) with severe morbidity and mortality risk are reviewed in light of the current literature.
CONCLUSION In conclusion, complications and deaths due to HA injury are less common today. The risk of complications increases in patients with hemodynamic instability, jaundice, cholangitis, and sepsis. Revealing the variations in the preoperative radiological evaluation will reduce the risks. In cases where HA injury is detected, arterial flow continuity should be tried to maintain with primary anastomosis, arterial transpositions, or grafts. In cases where bile duct injury develops, patients should be directed to HPB surgery centers, considering the possibility of accompanying HA injury. Large-scale and multicentric studies are needed to understand better the early and long-term results of HA ligation and determine preventive procedures.
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Affiliation(s)
- Osman Nuri Dilek
- Department of General Surgery, Division of Hepatopancreatobiliary Surgery, İzmir Katip Celebi University School of Medicine, İzmir 35150, Turkey
| | - Arif Atay
- Department of Surgery, İzmir Katip Celebi University School of Medicine, İzmir 35150, Turkey
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Choi TW, Chung JW, Kim HC, Lee M, Choi JW, Jae HJ, Hur S. Anatomic Variations of the Hepatic Artery in 5625 Patients. Radiol Cardiothorac Imaging 2021; 3:e210007. [PMID: 34498005 DOI: 10.1148/ryct.2021210007] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 04/20/2021] [Accepted: 07/19/2021] [Indexed: 12/27/2022]
Abstract
Purpose To analyze the origin and anatomic course of the hepatic arteries by using digital subtraction angiography (DSA) and multidetector CT in a large study sample. Materials and Methods This retrospective study included 5625 patients who underwent liver CT and chemoembolization between January 2005 and December 2018 (mean age, 60 years ± 11 [range, 11-99 years]; 4464 males). The CT and DSA images were reviewed to evaluate the visceral arterial anatomy for variations in the celiac axis and hepatic arteries. Aberrant right hepatic arteries (aRHAs) and aberrant left hepatic arteries (aLHAs) were defined on the basis of their origin and anatomic course. Statistical analyses were performed to evaluate the association between aRHAs and aLHAs and the association between variations in the hepatic artery and celiac axis. Results Right hepatic arteries were categorized as being aRHAs (if originating from the proximal to middle common hepatic artery, gastroduodenal artery, superior mesenteric artery [SMA], celiac axis, aorta, splenic artery, or left gastric artery [LGA]) or as being aLHAs (if arising from the LGA, celiac axis, aorta, or SMA). The prevalence of aRHAs (15.63%; 879 of 5625) and the prevalence aLHAs (16.32%; 918 of 5625) were similar. Patients with an aRHA were more likely to have an aLHA than those without an aRHA (29.01% vs 13.97%; P < .001), and patients with an aLHA were more likely to have an aRHA than those without an aLHA (27.78% vs 13.26%; P < .001). There was no association between the hepatic arterial variations and celiac axis variations. A hypothetical anatomic model summarizing the observed variations was created. Conclusion A comprehensive list of hepatic arterial variations and a three-dimensional hypothetical model for the observed variations were described.Keywords: CT, Angiography, Liver, Anatomy, Arteries© RSNA, 2021 Supplemental material is available for this article. See also commentary by Sutphin and Kalva in this issue.
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Affiliation(s)
- Tae Won Choi
- Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea
| | - Jin Wook Chung
- Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea
| | - Hyo-Cheol Kim
- Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea
| | - Myungsu Lee
- Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea
| | - Jin Woo Choi
- Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea
| | - Hwan Jun Jae
- Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea
| | - Saebeom Hur
- Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea
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Zhang Z, Zhang X, Liu Y, Li Y, Zhao Q, Fan L, Zhang Z, Wang D, Zhao X, Tan B. Meta-analysis of the efficacy of Da Vinci robotic or laparoscopic distal subtotal gastrectomy in patients with gastric cancer. Medicine (Baltimore) 2021; 100:e27012. [PMID: 34449473 PMCID: PMC8389896 DOI: 10.1097/md.0000000000027012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Revised: 07/20/2021] [Accepted: 08/05/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Robotic-assisted gastrectomy has been used for treating gastric cancer since 2002. This meta-analysis was conducted to systematically evaluate the efficacy of Da Vinci robotic distal subtotal gastrectomy (RDG) or laparoscopic distal subtotal gastrectomy (LDG) in patients with gastric cancer. METHODS We conducted searches in domestic and foreign databases, and collected literature in Chinese and English on the efficacy of RDG and LDG for gastric cancer that have been published since the inception of the database. RevMan 5.4.1 was used for meta-analysis and drawing and Stata14.0 was used for publication bias analysis. RESULTS A total of 3293 patients in 15 studies were included, including 1193 patients in the RDG group and 2100 patients in the LDG groups respectively. The meta-analysis showed that intraoperative blood loss was significantly lower and the number of resected lymph nodes was higher in the RDG group compared to that in the LDG group. In addition, the times to first postoperative food intake and postoperative hospital stay were shortened, and there was a longer length of distal resection margin and prolonged duration of operation. No significant differences were found between the 2 groups with respect to the first postoperative anal exhaust time, length of proximal resection margin, total postoperative complication rate, postoperative anastomotic leakage rate, incidence of postoperative gastric emptying disorder, pancreatic fistula rate, recurrence rate, and mortality rate. CONCLUSION RDG is a safe and feasible treatment option for gastric cancer, and it is non-inferior or even superior to LDG with respect to therapeutic efficacy and radical treatment.
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Affiliation(s)
- Zibo Zhang
- Hebei Medical University Fourth Affiliated Hospital and Hebei Provincial Tumor Hospital, Third Department of Surgery, Shijiazhuang, Hebe, China
| | - Xiaolin Zhang
- Hebei Medical University, School of Public Health, Shijiazhuang, Hebei, China
| | - Yu Liu
- Hebei Medical University Fourth Affiliated Hospital and Hebei Provincial Tumor Hospital, Third Department of Surgery, Shijiazhuang, Hebe, China
| | - Yong Li
- Hebei Medical University Fourth Affiliated Hospital and Hebei Provincial Tumor Hospital, Third Department of Surgery, Shijiazhuang, Hebe, China
| | - Qun Zhao
- Hebei Medical University Fourth Affiliated Hospital and Hebei Provincial Tumor Hospital, Third Department of Surgery, Shijiazhuang, Hebe, China
| | - Liqiao Fan
- Hebei Medical University Fourth Affiliated Hospital and Hebei Provincial Tumor Hospital, Third Department of Surgery, Shijiazhuang, Hebe, China
| | - Zhidong Zhang
- Hebei Medical University Fourth Affiliated Hospital and Hebei Provincial Tumor Hospital, Third Department of Surgery, Shijiazhuang, Hebe, China
| | - Dong Wang
- Hebei Medical University Fourth Affiliated Hospital and Hebei Provincial Tumor Hospital, Third Department of Surgery, Shijiazhuang, Hebe, China
| | - Xuefeng Zhao
- Hebei Medical University Fourth Affiliated Hospital and Hebei Provincial Tumor Hospital, Third Department of Surgery, Shijiazhuang, Hebe, China
| | - Bibo Tan
- Hebei Medical University Fourth Affiliated Hospital and Hebei Provincial Tumor Hospital, Third Department of Surgery, Shijiazhuang, Hebe, China
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Elsamaloty M, Schupp E, Ismail A, Borile C, Chun K, Sutton JM. A Rare Anatomic Variant of Double Replaced Hepatic Arteries: A Case Report and Brief Review of the Anomalous Hepatic Vasculature Literature. AMERICAN JOURNAL OF CASE REPORTS 2021; 22:e930990. [PMID: 33966033 PMCID: PMC8127860 DOI: 10.12659/ajcr.930990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 04/09/2021] [Accepted: 03/18/2021] [Indexed: 12/03/2022]
Abstract
BACKGROUND The liver is a frequent site of surgical resection for both benign and malignant lesions. Advanced knowledge of the hepatic arterial system and its variants is crucial to avoid incidental injuries during a resection procedure. Many variants have been previously described in the literature, yet extremely rare cases continue to be encountered in clinical practice. Documentation of these variants can thus allow for proper preoperative procedural planning when considering interventions involving the liver. Our aim is to present one such unique and extremely rare anomaly. CASE REPORT During routine cadaveric dissection of a 78-year-old man who had died of acute myeloid leukemia, a rare anatomic variant of the hepatic vasculature was revealed: a replaced right hepatic artery (rRHA) coming directly from the celiac trunk, a middle hepatic artery (MHA) continuing from the common hepatic artery (CHA), and a replaced left hepatic artery (rLHA) branching from the left gastric artery (LGA). To the best of our knowledge, this anomaly has only been described once before in the literature. CONCLUSIONS We report a rare anatomical variant of the hepatic vasculature. The significance of this variant must be considered during preoperative planning and the intra-arterial infusion of targeted drugs. This case further emphasizes the importance of proper medical imaging and documentation to ensure the best course of treatment for each patient. Given that this variant has only so far been identified in 2 post-mortem subjects, further work should include attempts at characterizing its physiologic effects in a living patient.
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Affiliation(s)
- Mazzin Elsamaloty
- College of Medicine and Life Sciences, University of Toledo Medical Center,Toledo, OH, U.S.A
| | - Eric Schupp
- College of Medicine and Life Sciences, University of Toledo Medical Center,Toledo, OH, U.S.A
| | - Abdighani Ismail
- College of Medicine and Life Sciences, University of Toledo Medical Center,Toledo, OH, U.S.A
| | - Clariza Borile
- College of Medicine and Life Sciences, University of Toledo Medical Center,Toledo, OH, U.S.A
| | - Krista Chun
- College of Medicine and Life Sciences, University of Toledo Medical Center,Toledo, OH, U.S.A
| | - Jeffrey M. Sutton
- Division of Surgical Oncology, Department of Surgery, University of Toledo Medical Center, Toledo, OH, U.S.A
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Wang JM, Li JF, Yuan GD, He SQ. Robot-assisted versus laparoscopic minor hepatectomy: A systematic review and meta-analysis. Medicine (Baltimore) 2021; 100:e25648. [PMID: 33907124 PMCID: PMC8084038 DOI: 10.1097/md.0000000000025648] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 02/14/2021] [Accepted: 03/17/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Robot-assisted and laparoscopic surgery are the most minimally invasive surgical approaches for the removal of liver lesions. Minor hepatectomy is a common surgical procedure. In this study, we evaluated the advantages and disadvantages of robot-assisted vs laparoscopic minor hepatectomy (LMH). METHODS A systematic literature search was performed in PubMed, Embase, and the Cochrane Library to identify comparative studies on robot-assisted vs. laparoscopicminor hepatectomy up to February, 2020. The odds ratios (OR) and mean differences with 95% confidence intervals were calculated using the fixed-effects model or random-effects model. RESULTS A total of 12 studies involving 751 patients were included in the meta-analysis. Among them, 297 patients were in the robot-assisted minor hepatectomy (RMH) group and 454 patients were in the LMH group. There were no significant differences in intraoperative blood loss (P = .43), transfusion rates (P = .14), length of hospital stay (P > .64), conversion rate (P = .62), R0 resection rate (P = .56), complications (P = .92), or mortaliy (P = .37) between the 2 groups. However, the RMH group was associated with a longer operative time (P = .0003), and higher cost (P < .00001) compared to the LMH group. No significant differences in overall survival or disease free survival between the 2 groups were observed. In the subgroup analysis of left lateral sectionectomies, RMH was still associated with a longer operative time, but no other differences in clinical outcomes were observed. CONCLUSIONS Although RMH is associated with longer operation times and higher costs, it exhibits the same safety and effectiveness as LMH. Prospective randomized controlled clinical trials should now be considered to obtain better evidence for clinical consensus.
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Kishino T, Kumamoto K, Kondo A, Noge S, Ando Y, Uemura J, Suto H, Asano E, Oshima M, Usuki H, Okano K, Suzuki Y. Early gastric cancer with an Adachi type VI (group 26) vascular anomaly diagnosed preoperatively and treated by laparoscopic surgery: a case report. BMC Surg 2021; 21:99. [PMID: 33622302 PMCID: PMC7903757 DOI: 10.1186/s12893-021-01100-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 02/14/2021] [Indexed: 12/24/2022] Open
Abstract
Background It is important to understand the branching pattern of the celiac artery for a safe surgery. Various branching anomalies of the celiac artery were classified by Adachi in 1928. In Adachi’s classification, type VI (group 26) is a rare anatomical anomaly (0.4%) that requires care when carrying out a surgery in gastric cancer patients with this anomaly. Herein, we reported a case treated successfully with laparoscopic distal gastrectomy with D1+ lymph node dissection for early gastric cancer. Case presentation An 84-year-old female was referred to our division for an additional surgical treatment for early gastric cancer that was resected by endoscopic submucosal dissection. A three-dimensional computed tomography angiography revealed an angioplany of the common hepatic artery branching from the left gastric artery. According to Adachi’s classification, the anomaly of this patient corresponded to type VI (group 26). Preoperative anatomical information of this rare anomaly helped us to safely perform a laparoscopic distal gastrectomy and lymph node dissection with common hepatic artery preservation. The patient had an uneventful postoperative course and was discharged on postoperative day 11. Conclusions We consider that Group 26 anomalies require the most precise anatomical understanding among Adachi classification type VIs, since it affects hepatic blood flow and can cause serious complications. In this time, we reported a successful case to perform laparoscopic distal gastrectomy with safety and accuracy by preoperative understanding of the precise vascular anatomy.
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Affiliation(s)
- Takayoshi Kishino
- Department of Gastroenterological Surgery, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa, 761-0793, Japan.
| | - Kensuke Kumamoto
- Department of Gastroenterological Surgery, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa, 761-0793, Japan
| | - Akihiro Kondo
- Department of Gastroenterological Surgery, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa, 761-0793, Japan
| | - Seiji Noge
- Department of Gastroenterological Surgery, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa, 761-0793, Japan
| | - Yasuhisa Ando
- Department of Gastroenterological Surgery, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa, 761-0793, Japan
| | - Jun Uemura
- Department of Gastroenterological Surgery, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa, 761-0793, Japan
| | - Hironobu Suto
- Department of Gastroenterological Surgery, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa, 761-0793, Japan
| | - Eisuke Asano
- Department of Gastroenterological Surgery, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa, 761-0793, Japan
| | - Minoru Oshima
- Department of Gastroenterological Surgery, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa, 761-0793, Japan
| | - Hisashi Usuki
- Department of Gastroenterological Surgery, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa, 761-0793, Japan
| | - Keiichi Okano
- Department of Gastroenterological Surgery, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa, 761-0793, Japan
| | - Yasuyuki Suzuki
- Department of Gastroenterological Surgery, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa, 761-0793, Japan
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16
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Kitadani J, Ojima T, Nakamura M, Hayata K, Katsuda M, Takeuchi A, Tominaga S, Fukuda N, Motobayashi H, Nakai T, Yamaue H. Safety and feasibility of laparoscopic gastrectomy for remnant gastric cancer compared with open gastrectomy: Single-center experience. Medicine (Baltimore) 2021; 100:e23932. [PMID: 33530194 PMCID: PMC7850663 DOI: 10.1097/md.0000000000023932] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Accepted: 11/27/2020] [Indexed: 01/05/2023] Open
Abstract
The usefulness, safety and oncological validity of laparoscopic gastrectomy (LG) for remnant gastric cancer (RGC) have not been widely reported.A total of 38 patients who underwent gastrectomy for RGC were enrolled at Wakayama Medical University Hospital between April 2008 and December 2018. All consecutive patients were included in this retrospective study; the patients were divided into the open gastrectomy group and the laparoscopic group according to the sequential nature of their operation. Fifteen patients underwent open gastrectomy for RGC (OGR) between April 2008 and December 2013, and 23 patients underwent LG for RGC (LGR) after 2014.In the OGR group, all initial operations were performed by open surgery, whereas in the LGR group, 11 patients (47%) initially underwent laparoscopic surgery and 12 patients (53%) initially underwent open surgery (P = .002), 3 patients of which (25%) converted to open gastrectomy. There was no significant difference in the number of lymph node dissections or in operative time between the 2 groups, but blood loss was significantly lower in the LGR group than that in the OGR group (P = .002). Furthermore, although there was no difference between the 2 groups in C-reactive protein value on postoperative day 1, C-reactive protein value on postoperative day 3 was significantly lower in the LGR group than in the OGR group (P = .012). There were no differences in postoperative complications or long-term outcomes, including recurrence-free survival and overall survival.LGy is suitable in cases in which the initial surgery is performed by laparoscopic surgery. Even if the initial surgery is open surgery, it is oncologically equivalent to open gastrectomy and can be performed safely with less blood loss.
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Kuribara T, Ichikawa T, Osa K, Inoue T, Ono S, Asanuma K, Kaneko S, Sano T, Shigeyoshi I, Matsubara K, Irie N, Iai A, Shinobi T, Ishizu H, Miura K. Combined resection of the hepatic artery without reconstruction in pancreaticoduodenectomy: a case report of pancreatic cancer with an aberrant hepatic artery. Surg Case Rep 2020; 6:228. [PMID: 32990830 PMCID: PMC7524997 DOI: 10.1186/s40792-020-00997-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Accepted: 09/18/2020] [Indexed: 12/22/2022] Open
Abstract
Background Pancreaticoduodenectomy (PD) is rarely performed for pancreatic cancer with hepatic arterial invasion owing to its poor prognosis and high surgical risks. Although there has been a recent increase in the reports of PD combined with hepatic arterial resection due to improvements in disease prognosis and operative safety, PD with major arterial resection and reconstruction is still considered a challenging treatment. Case presentation A 61-year-old man with back pain was diagnosed with pancreatic head and body cancer. Although distant metastasis was not confirmed, the tumor had extensively invaded the hepatic artery; therefore, we diagnosed the patient with locally advanced unresectable pancreatic cancer. After gemcitabine plus nab-paclitaxel (GnP) therapy, the tumor considerably decreased in size from 35 to 20 mm. Magnetic resonance imaging revealed a gap between the tumor and the hepatic artery. Tumor marker levels returned to their normal range, and we decided to perform conversion surgery. In this case, an artery of liver segment 2 (A2) had branched from the left gastric artery; therefore, we decided to preserve A2 and perform PD combined with hepatic arterial resection without reconstruction. After four cycles of GnP therapy, we performed hepatic arterial embolization to prevent postoperative ischemic complications prior to surgery. Immediately after embolization, collateral arterial blood flow to the liver was observed. Operation was performed 19 days after embolization. Although there was a temporary increase in liver enzyme levels and an ischemic region was found near the surface of segment 8 of the liver after surgery, no liver abscess developed. The postoperative course was uneventful, and S-1 was administered for a year as adjuvant chemotherapy. The patient is currently alive without any ischemic liver events and cholangitis and has not experienced recurrence in the past 4 years since the surgery. Conclusions In PD for pancreatic cancer with hepatic arterial invasion, if a part of the hepatic artery is aberrant and can be preserved, combined resection of the common and proper hepatic artery without reconstruction might be feasible for both curability and safety.
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Affiliation(s)
- Tadao Kuribara
- Department of Surgery, Saitama Cooperative Hospital, 1317 Kizoro, Kawaguchi-shi, Saitama, 333-0831, Japan.
| | - Tatsuo Ichikawa
- Department of Surgery, Saitama Cooperative Hospital, 1317 Kizoro, Kawaguchi-shi, Saitama, 333-0831, Japan
| | - Kiyoshi Osa
- Department of Surgery, Saitama Cooperative Hospital, 1317 Kizoro, Kawaguchi-shi, Saitama, 333-0831, Japan
| | - Takeshi Inoue
- Department of Surgery, Saitama Cooperative Hospital, 1317 Kizoro, Kawaguchi-shi, Saitama, 333-0831, Japan
| | - Satoshi Ono
- Department of Surgery, Saitama Cooperative Hospital, 1317 Kizoro, Kawaguchi-shi, Saitama, 333-0831, Japan
| | - Kozo Asanuma
- Department of Surgery, Saitama Cooperative Hospital, 1317 Kizoro, Kawaguchi-shi, Saitama, 333-0831, Japan
| | - Shiori Kaneko
- Department of Surgery, Saitama Cooperative Hospital, 1317 Kizoro, Kawaguchi-shi, Saitama, 333-0831, Japan
| | - Takayuki Sano
- Department of Surgery, Saitama Cooperative Hospital, 1317 Kizoro, Kawaguchi-shi, Saitama, 333-0831, Japan
| | - Itaru Shigeyoshi
- Department of Surgery, Saitama Cooperative Hospital, 1317 Kizoro, Kawaguchi-shi, Saitama, 333-0831, Japan
| | - Kouta Matsubara
- Department of Surgery, Saitama Cooperative Hospital, 1317 Kizoro, Kawaguchi-shi, Saitama, 333-0831, Japan
| | - Naoko Irie
- Department of Surgery, Saitama Cooperative Hospital, 1317 Kizoro, Kawaguchi-shi, Saitama, 333-0831, Japan
| | - Akira Iai
- Department of Surgery, Saitama Cooperative Hospital, 1317 Kizoro, Kawaguchi-shi, Saitama, 333-0831, Japan
| | - Tetsuya Shinobi
- Department of Internal Medicine, Saitama Cooperative Hospital, 1317 Kizoro, Kawaguchi-shi, Saitama, Japan
| | - Hideki Ishizu
- Department of Pathology, Saitama Cooperative Hospital, 1317 Kizoro, Kawaguchi-shi, Saitama, Japan
| | - Katsuhiro Miura
- Department of Internal Medicine, Saitama Cooperative Hospital, 1317 Kizoro, Kawaguchi-shi, Saitama, Japan.,Tumor Center, Nihon University Itabashi Hospital, 30-1, Oyaguchikamicho, Itabashi-ku, Tokyo, Japan.,Department of Hematology and Rheumatology, Nihon University School of Medicine, 30-1, Oyaguchikamicho, Itabashi-ku, Tokyo, Japan
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18
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Amato B, Patrone R, Quarto G, Compagna R, Cirocchi R, Popivanov G, Granata V, Belli A, Izzo F. Surgical treatment for common hepatic aneurysm. Original one-step technique. Open Med (Wars) 2020; 15:898-904. [PMID: 33336047 PMCID: PMC7712245 DOI: 10.1515/med-2020-0104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 07/09/2020] [Accepted: 07/31/2020] [Indexed: 12/22/2022] Open
Abstract
Introduction Hepatic artery aneurysms are rare, and their treatment represents a challenge for the surgeons. Materials and methods A new technique is presented for common hepatic artery (CHA) aneurysm: it requires minimal vascular surgical dissection and only one linear vascular stapler is applied at the bottom of aneurysm. Aneurysm exclusion is easily obtained, which allowed retrograde thrombosis. Liver blood supply is ensured to the right and left hepatic artery, through the gastroduodenal artery, and can be previously monitored, with temporary clamping of the section area, by visual control, enzyme evaluation and intraoperative ultrasound examination. We reported an open surgical treatment, with simultaneous removal of hepatic and adrenal metastases, secondary to colon cancer. Results The duration of vascular surgery was 30 min and did not involve complications. Postoperative controls confirmed the efficacy of the procedure. Discussion This original technique can be added to the various open and endovascular techniques so far described for the treatment of a CHA aneurysm. It is advisable as open surgery, mostly in case of associated pathologies. Conclusions The authors believe that this "one shot" technique by vascular staple of the distal part of CHA is minimally invasive and effective to obtain the exclusion of the aneurysm.
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Affiliation(s)
- Bruno Amato
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Medical School, Naples, Italy
| | - Renato Patrone
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Medical School, Naples, Italy
| | - Gennaro Quarto
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Medical School, Naples, Italy
| | - Rita Compagna
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Medical School, Naples, Italy
| | - Roberto Cirocchi
- Department of Surgical Sciences, University of Perugia, Perugia, Italy
| | - Georgi Popivanov
- Department of Surgery, Military Medical Academy, Sofia, Bulgaria
| | - Vincenza Granata
- Department of Radiology, "Istituto Nazionale Tumori IRCCS Fondazione G. Pascale - Napoli", Naples, Italy
| | - Andrea Belli
- Department of Surgical Oncology, Hepatobiliary Unit, "Istituto Nazionale Tumori IRCCS Fondazione G. Pascale - Napoli", Naples, Italy
| | - Francesco Izzo
- Department of Surgical Oncology, Hepatobiliary Unit, "Istituto Nazionale Tumori IRCCS Fondazione G. Pascale - Napoli", Naples, Italy
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20
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Ang RRG, Lee HJ, Bae JS, Zhu CC, Berlth F, Kim TH, Park SH, Suh YS, Kong SH, Kim SH, Yang HK. Safety of Ligation of Aberrant Left Hepatic Artery Originating from Left Gastric Artery in Laparoscopic Gastrectomy for Gastric Cancer. Sci Rep 2020; 10:5856. [PMID: 32246010 PMCID: PMC7125141 DOI: 10.1038/s41598-020-62587-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Accepted: 02/26/2020] [Indexed: 02/07/2023] Open
Abstract
There are still lot of controversies whether aberrant left hepatic artery (ALHA) originating from left gastric artery should be ligated or preserved during gastric cancer (GC) surgery. We aimed to investigate this issue. We reviewed ALHA cases who had laparoscopic gastrectomy for gastric cancer at Seoul National University Hospital (SNUH) from 2012 to 2016. Type of ALHA variants using Michel's classification of hepatic arterial anatomy and diameter of each vessel were evaluated by 2 radiologists. Postoperative hepatic function and surgical outcome were collected until 6 months after surgery. Results showed that if the diameter of ALHA was larger than 1.5 mm, a transient elevation of SGOT and SGPT on postoperative day 2 was observed in the ligated cases. No differences were observed in operation time, amount of blood loss, overall complication rate, hospital stay, and number of lymph nodes retrieved between the ligated and preserved replaced left hepatic artery (RLHA) and accessory left hepatic artery (acLHA) group. In this study, we conclude that ligation of ALHA seems to be safe as none of the patients suffered adverse outcome. A transient rise in postoperative SGOT and SGPT levels were seen after ligating ALHA >1.5 mm in diameter regardless of subtype.
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Affiliation(s)
- Rene Ronson G Ang
- Department of Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
- Department of Surgery, Cebu Doctors' University Hospital, Cebu City, Philippines
- Department of Surgery, University of Cebu Medical Center, Cebu City, Philippines
| | - Hyuk-Joon Lee
- Department of Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea.
| | - Jae Seok Bae
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
| | - Chun-Chao Zhu
- Department of Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
- Department of Gastrointestinal Surgery, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Felix Berlth
- Department of Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
- Department of General, Visceral and Cancer Surgery, University of Cologne, Köln, Germany
| | - Tae Han Kim
- Department of Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
- Department of Surgery, Gyeongsang National University Changwon Hospital, Changwon, Korea
| | - Shin-Hoo Park
- Department of Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Yun-Suhk Suh
- Department of Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Seong-Ho Kong
- Department of Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Se Hyung Kim
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
| | - Han-Kwang Yang
- Department of Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
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Legocka ME, Toutounchi S, Pogorzelski R, Krajewska E, Celejewski K, Galazka Z. Undiagnosed Pheochromocytoma Presenting as a Pancreatic Tumor: A Case Report. Open Med (Wars) 2020; 15:103-106. [PMID: 32161778 PMCID: PMC7053398 DOI: 10.1515/med-2020-0015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 01/06/2019] [Indexed: 12/31/2022] Open
Abstract
Pheochromocytoma is a rare catecholamine-producing tumor of the adrenal gland. Patients with known pheochromocytoma undergoing surgery require preoperative treatment with alpha-blockers to reduce the risk of intraoperative complications related to catecholamine release. If undiagnosed, pheochromocytoma can lead to life-threatening surgical complications. We report the case of a patient with a suspected solid pseudopapillary neoplasm in the pancreatic tail, for whom pancreatoduodenectomy was scheduled. However, shortly after abdominal incision, hypertensive crisis developed and was followed by severe hypotension requiring intravenous vasopressors, which prompted discontinuation of the operation. Further diagnostic evaluation revealed marked elevations in urinary excretion of methylated catecholamines and suggested that the tumor was in fact a pheochromocytoma extending from the left adrenal gland. After preoperative treatment with doxazosin, the patient underwent lateral transperitoneal laparoscopic adrenalectomy, with no major complications and an uneventful postoperative course. The pathological report confirmed a diagnosis of pheochromocytoma. Due to the potential for life-threatening surgical complications in patients with pheochromocytoma not treated preoperatively with alpha-blockers, this tumor type should be included in the differential diagnosis of abdominal tumors of unknown origin.
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Affiliation(s)
- Malgorzata Emilia Legocka
- Department of General, Endocrinological and Vascular Surgery, Medical University of Warsaw, Warsaw 02-097 Poland
| | | | - Ryszard Pogorzelski
- Department of General, Endocrinological and Vascular Surgery, Medical University of Warsaw, Warsaw 02-097 Poland
| | - Ewa Krajewska
- Department of General, Endocrinological and Vascular Surgery, Medical University of Warsaw, Warsaw 02-097 Poland
| | - Krzysztof Celejewski
- Department of General, Endocrinological and Vascular Surgery, Medical University of Warsaw, Warsaw 02-097 Poland
| | - Zbigniew Galazka
- Department of General, Endocrinological and Vascular Surgery, Medical University of Warsaw, Warsaw 02-097 Poland
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