Implications of the replaced right hepatic artery originating from the gastroduodenal artery in the setting of a pancreatic head mass

Purpose: The anatomic variability of the hepatic artery has important implications in the treatment of periampullary cancers. The purpose is of this report is to describe the importance of the replaced right hepatic artery originating from the gastroduodenal artery, which is typically removed during a pancreatic head resection, and to demonstrate how this variant can markedly alter treatment planning and intraoperative decision making. Materials and methods: In this report, two cases of a replaced right hepatic artery originating from the gastroduodenal artery are described in the setting of a borderline-resectable pancreatic adenocarcinoma identified on preoperative CT imaging. Results: The importance of identifying this variant preoperatively is highlighted. In addition, the implications involved in preserving the replaced right hepatic artery are emphasized, requiring preservation of a portion of the gastroduodenal artery within the pancreatic parenchyma during pancreaticoduodenectomy. Conclusion: The location of this variant in the setting of a pancreatic head malignancy mandates its attention by a multidisciplinary team of radiologists, radiation oncologists, medical oncologists, and surgeons, prior to pancreaticoduodenectomy.