Celiac Trunk and Hepatic Arterial Variations in Pancreaticoduodenectomy: Surgical Outcomes and Hidden Risks

Objectives: Pancreaticoduodenectomy is a technically demanding procedure with considerable morbidity and mortality where detailed knowledge of vascular anatomy is essential. Variations of the celiac trunk and hepatic artery are relatively common and may influence surgical strategy, lymph node dissection and perioperative outcomes. However, their impact on operative and onco-logical parameters remains controversial. This study aimed to evaluate the impact of celiac trunk and hepatic artery variations on operative time, lymph node yield and early postoperative liver function in patients undergoing pancreaticoduodenectomy.
Methods: A single-center retrospective study was conducted including 117 patients who underwent PD between January 2016 and March 2025. Preoperative contrast-enhanced computed tomography angiography was used to assess hepatic arterial anatomy according to the Michels classification. Patients were grouped as normal anatomy (Type I) and arterial variation (Types II–X). Clinical, operative and pathological parameters were compared.
Results: Arterial variations were identified in 32.5% of patients. Operative time was significantly longer in the variation group compared to normal anatomy (315 vs 240 minutes, p=0.002). Total lymph node yield was significantly lower in patients with arterial variation (12 vs 21, p<0.001) whereas malignant lymph node count and lymph node ratio were similar between groups. No signifi-cant differences were observed in postoperative liver function tests, including ALT and AST levels. Subgroup analysis demonstrated that left sided variations were associated with the longest operative times. Regression analysis confirmed arterial variation as an independent predictor of prolonged operative time (B=55.763, p=0.001).
Conclusion: Celiac trunk and hepatic artery variations significantly prolong operative time and are associated with reduced lymph node yield in pancreaticoduodenectomy without adversely affecting early postoperative liver function. Preoperative identification of these variations is crucial for optimal surgical planning and may have implications for oncological adequacy.

Keywords: Arterial variations, pancreaticoduodenectomy, vascular pitfalls