Supplementary Material for: Hepatic Artery Anomalies in Pancreaticoduodenectomy: Outcomes from a High-Volume Center

Introduction Hepatic artery anomalies (HAA) and may have an impact on surgical and oncological outcomes of patients undergoing pancreaticoduodenectomy (PD). Methods Patients undergone PD at our Institution between July 2015 and January 2020 were retrospectively reviewed and classified into two groups: Group 1, presence of HAA and Group 2, no HAA. A weighted logistic regression model employed to assess the association between HAA and postoperative complications, and to assess the association between HAA and R status in patients with pancreatic cancer. Results 502 patients were considered for analysis, with 75 (15%) of them in Group 1. They had either an accessory (aRHA, n=28, 40.8%) or replaced (rRHA, n=26, 36.6%) right hepatic artery. Most patients underwent surgery for a malignancy (n= 451; 90%); among them, vascular resection was performed in 69 cases (15%). The presence of a HAA was reported at pre-operative imaging only in 4 cases (5%)and the aberrant vessel was preserved in 72% of patients. At weighted multivariable logistic regression analysis, HAA were not associated to higher odds of morbidity (OR 0.753, 95%CI 0.543-1.043) nor to R1 status in case of pancreatic cancer (OR 1.583, 95%CI 0.979-2.561). Conclusion In our institution the presence of HAA doesn’t have an impact on post-operative outcomes nor affects oncological clearance in PD. Hospitals’, surgeon’s volume and systematic review of preoperative imaging are all factors that help to reduce possible adverse events.引言 肝动脉变异（hepatic artery anomalies, HAA）可能对接受胰十二指肠切除术（pancreaticoduodenectomy, PD）患者的手术及肿瘤学结局产生影响。 方法 回顾性分析2015年7月至2020年1月期间于本机构接受PD的患者，将其分为两组：第1组为合并HAA患者，第2组为未合并HAA患者。采用加权逻辑回归模型，评估HAA与术后并发症的关联，以及HAA与胰腺癌患者术后切缘状态（R status）的关联。 结果 本研究共纳入502例患者进行分析，其中第1组75例，占总病例数的15%。患者的肝动脉变异类型包括副右肝动脉（accessory right hepatic artery, aRHA，n=28，占比40.8%）与替代型右肝动脉（replaced right hepatic artery, rRHA，n=26，占比36.6%）。多数患者因恶性肿瘤接受手术（n=451，占比90%），其中69例（15%）接受了血管切除术。术前影像学检查仅检出4例（5%）HAA，72%的异常血管得以保留。经加权多变量逻辑回归分析显示，HAA与更高的术后并发症发生率无显著关联（比值比OR=0.753，95%置信区间CI：0.543~1.043）；在胰腺癌患者中，HAA也与R1切缘状态无显著关联（OR=1.583，95%CI：0.979~2.561）。 结论 在本机构中，HAA的存在对PD患者的术后结局及肿瘤学切缘清除率均无显著影响。医院与术者的手术量、术前影像学的系统评估，均为降低不良事件发生风险的重要相关因素。