Clinical significance of variant hepatic artery in pancreatic resection: A comprehensive review

Abstract

The anatomical structure of the pancreaticoduodenal region is complex and closely related to the surrounding vessels. A variant of the hepatic artery, which is not a rare finding during pancreatic surgery, is prone to intraoperative injury. Inadvertent injury to the hepatic artery may affect liver perfusion, resulting in necrosis, liver abscess, and even liver failure. The preoperative identification of hepatic artery variations, detailed planning of the surgical approach, careful intraoperative dissection, and proper management of the damaged artery are important for preventing hepatic hypoperfusion. Nevertheless, despite the potential risks, planned artery resection has become acceptable in carefully selected patients. Arterial reconstruction is sometimes essential to prevent postoperative ischemic complications and can be performed using various methods. The complexity of procedures such as pancreatectomy with en bloc celiac axis resection may be mitigated by the presence of an aberrant right hepatic artery or a common hepatic artery originating from the superior mesenteric artery. Here, we comprehensively reviewed the anatomical basis of hepatic artery variation, its incidence, and its effect on the surgical and oncological outcomes after pancreatic resection. In addition, we provide recommendations for the prevention and management of hepatic artery injury and liver hypoperfusion. Overall, the hepatic artery variant may not worsen surgical and oncological outcomes if it is accurately identified pre-operatively and appropriately managed intraoperatively.

Keywords: Hepatic artery, Pancreatectomy, Pancreaticoduodenectomy, Arterial reconstruction, Celiac axis resection, Outcome, Prognosis

Core Tip: Variations in hepatic artery anatomy are not rare during pancreatic surgery and have a significant impact on planning and performance of the procedure. Inadvertent intraoperative injury to hepatic artery may affect liver perfusion and result in ischemic complications. Detailed knowledge and awareness of its anatomical variants are critical, and thorough pre- and intraoperative planning is important to prevent hepatic hypoperfusion. This article comprehensively reviews the hepatic artery anatomy and variations, highlights its impact on surgical and oncological outcomes after pancreatic resection, and discusses prevention and management of hepatic artery injury and liver hypoperfusion.