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

Table 1 Incidences of aberrant right and common hepatic artery during pancreaticoduodenectomy in the English literature (> 50 cases)

Ref.	Year	Total, n	Male, n	PDAC, n	a/rRHA, n (%)	aRHA1, n (%)	rRHA1, n (%)	rCHA, n (%)	Detecting methods
Wang et al[7]	2021	576	317	149	72 (12.5)	27 (4.7)	28 (4.9)	20 (3.5)	CTA
Mansour et al[5]	2021	202	NA	NA	37 (18.3)	3 (1.5)	29 (14.4)	0	Surgical finding
Giani et al[25]	2021	270	NA	NA	66 (24.4)	3 (1.1)	39 (14.4)	10 (3.7)	CT
Zhang et al[3]	2020	218	122	61	36 (16.5)	13 (6.0)	11 (5.1)	7 (3.2)	CTA
Crocetti et al[34]	2019	297	178	297	44 (14.8)	NA	NA	NA	CTA, surgical finding
Alexakis et al[4]	2019	232	NA	NA	32 (13.8)	19 (8.2)	13 (5.6)	1 (0.4)	Surgical finding
Balzan et al[9]	2019	200	93	NA	26 (13.0)	2 (1.0)	17 (8.5)	7 (3.5)	CT
Kim et al[33]	2016	73	35	24	15 (20.5)	4 (5.5)	11 (15.1)	NA	CT, surgical finding
Nguyen et al[31]	2015	142	76	57	16 (11.3)	0	14 (9.9)	9 (6.3)	CT, surgical finding
Yang et al[32]	2015	458	242	291	54 (11.8)	15 (3.3)	29 (6.3)	10 (2.2)	CT, DSA, surgical finding
Rammohan et al[17]	2014	225	167	31	42 (18.7)	10 (4.4)	31 (13.8)	1 (0.4)	CT, surgical finding
Kim et al[26]	2014	289	158	289	38 (13.1)	3 (1.0)	31 (10.7)	2 (0.7)	Surgical finding
Sulpice et al[30]	2013	213	NA	NA	29 (13.6)	NA	NA	NA	CT, surgical finding
Turrini et al[29]	2010	471	NA	471	47 (10.0)	2 (0.4)	44 (9.3)	NA	CT, surgical finding
Lee et al[28]	2009	103	73	0	15 (14.6)	0	12 (11.7)	0	MRA, surgical finding
Total		3969	1461	1670	540 (14.4)	101 (2.9)	309 (8.9)	67 (2.3)

¹These columns contain only variants of the right hepatic artery originating from the superior mesenteric artery.

a/rRHA: Accessory/replaced right hepatic artery; aRHA: Accessory right hepatic artery; CT: Computed tomography; CTA: Computed tomography angiography; CHA: Common hepatic artery; DSA: Digital subtraction angiography; NA: Not available; MRA: Magnetic resonance angiography; PDAC: Pancreatic ductal adenocarcinoma; rCHA: Replaced common hepatic artery; RHA: Right hepatic artery; rRHA: Replaced right hepatic artery.

Table 2 Surgical outcomes of pancreaticoduodenectomy in patients with and without aberrant hepatic artery (> 50 cases)

Ref.	Total, n	AHA, n	Morbidity, n (%)		POPF, n (%)		PPH, n (%)		DGE, n (%)		Reoperation, n (%)		Mortality, n (%)
			AHA	n-AHA	AHA	n-AHA	AHA	n-AHA	AHA	n-AHA	AHA	n-AHA	AHA	n-AHA
OPD
Rammohan et al[17]	225	43	26 (60.5)	111 (61.0)	2 (4.7)	9 (4.9)	1 (2.3)	4 (2.1)	23 (53.4)	98 (53.8)	NA	NA	1 (2.3)	3 (1.7)
Kim et al[26]	249	371	92 (24.3)	882 (41.5)	1 (2.7)	12 (5.6)	1 (2.7)	16 (7.6)	4 (10.8)	16 (7.6)	NA	NA	0	1 (0.5)
Sulpice3 et al[30]	84	291	14 (48.3)	32 (58.2)	3 (10.3)	9 (16.4)	4 (13.8)	9 (16.4)	10 (34.5)	24 (43.6)	NA	NA	3 (10.3)	3 (5.5)
Eshuis et al[53]	758	143	80 (55.9)	303 (49.3)	18 (12.6)	87 (14.1)	11 (7.7)	44 (7.2)	48 (33.6)	193 (31.4)	10 (7.0)	68 (11.0)	2 (1.4)	13 (2.1)
Mansour3 et al[5]	82	41	22 (53.7)	27 (65.9)	8 (19.5)	12 (29.3)	4 (9.8)	3 (7.3)	6 (14.6)	7 (17.1)	0	0	1 (2.4)	0
Crocetti et al[34]	297	441	32 (72.7)	185 (73.1)	5 (11.3)	27 (10.7)	2 (4.5)	12 (4.7)	5 (11.4)	37 (14.6)	3 (6.8)	28 (11.7)	7 (15.9)	33 (13.0)
Alexakis3 et al[4]	105	35	4 (11.4)	19 (27.1)	2 (5.7)	9 (12.9)	0	2 (2.9)	1 (2.9)	1 (1.4)	1 (2.9)	5 (7.1)	2 (5.7)	4 (5.7)
LPD
Wang et al[7]	576	127	NA	NA	21 (16.5)	68 (15.1)	11 (9.0)	37 (8.2)	3 (2.5)	9 (2.0)	4 (3.1)	24 (5.3)	4 (3.1)	12 (2.7)
Giani et al[25]	72	141	5 (35.7)	34 (58.6)	2 (14.3)	10 (17.2)	2 (14.3)	10 (17.2)	2 (14.3)	14 (24.1)	NA	NA	0	4 (6.9)
Zhang et al[3]	218	54	22 (40.7)	70 (42.7)	5 (2.3)	21 (9.6)	5 (2.3)	15 (6.9)	NA	NA	NA	NA	3 (3.7)	7 (4.3)
RPD
Nguyen et al[31]	142	30	19 (63.3)	74 (66.0)	4 (13.3)	9 (8.1)	NA	NA	3 (10.0)	26 (23.2)	NA	NA	2 (6.7)	3 (2.7)
Kim et al[33]	73	151	5 (33.3)	29 (50.0)	2 (13.3)	5 (8.6)	1 (6.7)	5 (8.6)	NA	NA	2 (13.3)	4 (6.9)	0	2 (3.4)

¹AHA in these studies included only right hepatic artery variants.

²The P value for this comparison was 0.04, while all others were > 0.05.

³These studies provided matched analysis.

AHA: Aberrant hepatic artery; DGE: Delayed gastric emptying; LPD: Laparoscopic pancreaticoduodenectomy; n-AHA: Non-aberrant hepatic artery; NA: Not available; OPD: Open pancreaticoduodenectomy; POPF: Postoperative pancreatic fistula; PPH: Post-pancreatectomy hemorrhage; RPD: Robotic pancreaticoduodenectomy.

Table 3 Oncological outcomes of pancreaticoduodenectomy in patients with and without aberrant hepatic artery (> 50 cases)

Author	Total, n	AHA, n	R0 resection, n (%)		Median OS (mo)		Median HLN, n
			AHA	n-AHA	AHA	n-AHA	AHA	n-AHA
OPD
Crocetti et al[34]	297	441	42 (95.5)	220 (87.0)	30	25	NA	NA
Alexakis2 et al[4]	105	35	29 (82.9)	56 (80.0)	NA	NA	NA	NA
Rubio-Manzanares-Dorado et al[62]	151	11	11 (100.0)	116 (82.9)	NA	NA	10	12
Rammohan et al[17]	225	43	40 (93.1)	169 (92.9)	NA	NA	12	12
Kim et al[26]	249	371	33 (89.2)	178 (84.0)	17	23	17	17
Sulpice2 et al[30]	84	291	25 (86.2)	49 (89.1)	21.8	23.6	16	26
Turrini et al[29]	62	31	25 (80.7)	26 (83.9)	23	17	11	13
Lee et al[28]	103	151	12 (80.0)	66 (75.0)	29.8	28.7	NA	NA
LPD
Wang et al[7]	576	127	NA	NA	28	32	15	14
Giani et al[25]	72	141	11 (84.6)	50 (86.2)	NA	NA	223	173
Zhang et al[3]	218	54	54 (100.0)	163 (99.4)	NA	NA	18.59	18.26
RPD
Nguyen et al[31]	115	27	25 (92.6)	77 (87.5)	NA	NA	22.3	17.5

¹AHA in these studies included only right hepatic artery variants.

²These studies provided matched analysis.

³The P value for this comparison was 0.032, while all others were > 0.05.

AHA: Aberrant hepatic artery; HLN: Number of harvested lymph nodes; LPD: Laparoscopic pancreaticoduodenectomy; n-AHA: Non-aberrant hepatic artery; NA: Not available; OPD: Open pancreaticoduodenectomy; OS: Overall survival; RPD: Robotic pancreaticoduodenectomy.