Subtotal Stomach-preserving Pancreatoduodenectomy for Pancreatic Head Cancer with Selective Embolization of an Aberrant Right Hepatic Artery Originating from the Gastroduodenal Artery with Consequent Hepatic Artery Alteration—A Case Report—

Abstract

A 71-year-old woman was referred to our hospital with generalized fatigue after being diagnosed with jaundice and liver dysfunction at another hospital. Abdominal contrast-enhanced computed tomography revealed a groove pancreatic tumor measuring 30 mm in size and an aberrant right hepatic artery, which originated from the gastroduodenal artery and penetrated the tumor. Angiography revealed a stricture of the right hepatic artery and an enlarged communicating artery between the left and right hepatic arteries. Therefore, we performed preoperative embolization of the right hepatic artery. Six days later, subtotal stomach-preserving pancreatoduodenectomy was successfully performed with resection of the right hepatic artery. Surgical treatment of pancreatic head cancer should necessarily include the following steps : (a) preoperative imaging to accurately identify the aberrant hepatic artery and, (b) selection of the optimal approach based on the type of aberrant hepatic artery identified. We successfully performed safe and curative subtotal stomach-preserving pancreatoduodenectomy following preoperative embolization of the aberrant hepatic artery.