"Feasibility and Safety of Arterial Transfer for Microscopic Hepatic Artery Reconstruction After Hepatobiliary and Pancreatic Tumor Resection".

Abstract

Options for microscopic hepatic artery (HA) reconstruction include direct anastomosis (DA), arterial transfer (AT), and graft interposition (GI). Despite the advantage of AT in requiring only one anastomosis site, its clinical applicability and outcomes in HA reconstruction after hepatobiliary tumor resection remain underexplored. This study aimed to evaluate the feasibility and safety of AT compared with DA. A retrospective analysis of patients who underwent microscopic HA reconstruction after hepatobiliary tumor resection between 2003 and 2024 was performed. Feasibility was assessed based on the proportion of cases successfully reconstructed without GI and the distribution of cases among the DA, AT, and GI groups. Safety was evaluated by comparing the severity of overall complications, incidence of potential complications related to decreased HA flow, incidence of postoperative anastomotic thrombosis, and survival outcomes between the AT and DA groups. Among 130 patients, 99.2% of cases did not require GI, with the DA, AT, and GI groups accounting for 56%, 43%, and 0.8%, respectively. No significant differences between the AT and DA groups were observed in the severity of overall complications (p = 0.27), incidence of potential complications related to decreased HA flow (p = 0.50), postoperative anastomotic thrombosis (p > 0.99), or five-year overall survival rate (29.7% vs. 35.1%, p = 0.37). AT provides favorable outcomes comparable to DA, even in complex resections. AT is a safe and feasible option for microscopic HA reconstruction when DA is not feasible, effectively minimizing the need for GI.