Cancer of the head of the pancreas treated with pancreaticoduodenectomy with reconstruction of the replaced common hepatic artery

A replaced common hepatic artery (RCHA) originating from the superior mesenteric artery is a rare anomaly, and cancer of the head of the pancreas can easily invade the RCHA. Interruption of the hepatic arterial flow at the time of pancreaticoduodenectomy (PD) is associated with an increased risk of hepatic and biliary ischemia, which may consequently result in complications such as stenosis of the biliary-enteric anastomosis, and in biliary fistulae. Hence, PD accompanied by dissection and reconstruction of the RCHA is necessary. We here report a case of pancreatic head cancer with invasion of the RCHA. We performed a PD with dissection and reconstruction of the RCHA using the left gastric artery and proximal stump of the RCHA, without any serious complications. We conclude that for PD in patients with an RCHA, careful study of preoperative images is necessary, and that microsurgery for arterial reconstruction is beneficial for these patients.