Vascular anomalies in pancreatic head resection do not impact surgical outcome in high volume center

Background: Vascular anomalies(VA)in pancreaticoduodenectomy(PD)may impact both surgical and oncological outcome.Focused preoperative workout aims to detect these anomalies and therefore prevent intraoperative unwanted events.We present our experience of PD in patients with or without VA. Patients and methods: We retrospectively analysed pre, intra and post-operative data of patients from prospective datatbase with VA undergone PD and compared them to noVA. VA were: replaced and accessory right hepatic artery (rRHA,aRHA)), hepatomesenteric trunk (HMT) and celiac-axis (CA) stenosis. Operative time, blood loss, morbidity, lenght of stay, need of reoperation and R-status were specifically considered. Statistical analysis: Continous variables were analysed using Student´s t-test or Mann-Whitney U test. Categorical variables were compared using Chi-Square test or Fisher´s exact test when appropriate.A p-value< 0 .05 was considered as statistically significant. Results: 72 patients VA underwent PD and were compared with 72pts noVA observed in the same period. Abdominal complications occurred in 79,2% and 52,5% of noVA and VA respectively(p:0,001). Abdominal fluid collection in 38.9% vs 22,2% p:0.04, need for transfusion in 48,6% vs 20,8% p:0.001 and lenght of stay 17days vs 11,5 p:0.001 for noVA and VA respectively.At multivariate analysis LoS is significatively shorter in VA. Conclusion: In our series patients with VA have a better postoperative outcome and shorter stay: experienced surgeon used to plan preoperative strategy based on imaging and increased attention in lamina and selective vascular dissection when aware of the anomaly may play a role.Technical tricks to intraoperatively detect VA are known and need to be routinely applied.