CLINICAL STUDIES ON OCCLUSION OF THE HEPATIC ARTERY FOLLOWING ACCIDENTAL INJURY OR INTENTIONAL RESECTION AT SURGERY OF HEPATO-BILIARY-PANCREATIC MALIGNANCY

Seven cases operated on for hepato-biliary-pancreatic malignancy in which the hepatic artery was accidentaly injured or intentionally resected at the operation, were studied. There were three cases of accidental injuries (one transection and two thrombus formation) and four intentional resections because of cancer invasion. The sites of occlusion were the proper hepatic artery in three cases and the right hepatic artery in four cases. The injured vessels were reconstructed in two and ligated in the others. Complications included bilioenteric anastomotic breakdown in three cases, liver abscess in one and hepatic infarction in one. Death attributable to hepatic artery occlusion occurred in only one. It is concluded that reconstruction of the vessel is essential when the hepatic artery is interrupted at the level of the proper hepatic artery. When either the right or left branch is interrupted, the necessity of reconstruction depends on the extent of lymph node dissection of the hepatoduodenal ligament, the degree of back bleeding from the distal end, and the presence or absence of biliary tract reconstruction.