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Yan Y, Wang B, Yuan W, Zhang J, Xiao J, Sha Y. A rare case with multiple arterial variations of the liver complicated laparoscopic pancreaticoduodenectomy. BMC Gastroenterol 2022; 22:331. [PMID: 35799108 PMCID: PMC9260989 DOI: 10.1186/s12876-022-02398-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 06/22/2022] [Indexed: 11/17/2022] Open
Abstract
Background Hepatic arterial variations were fully elaborated in anatomical monographs. Here, we aimed to present a rare case with multiple arterial variations of the liver complicated laparoscopic pancreaticoduodenectomy. Case presentation We report a 67-year-old woman with a periampullary tumor underwent laparoscopic pancreaticoduodenectomy. Intraoperatively, the aberrant right hepatic artery derived from the gastroduodenal artery (GDA) was observed and had accidentally sacrificed due to untimely ligature of GDA. Three-dimensional reconstruction based on preoperative contrast-enhanced CT performed to better study the anatomy. It demonstrated a replaced right hepatic artery branched from the GDA and supplied right liver lobe. Meanwhile, the middle hepatic artery derived from the common hepatic artery and supplied hepatic segment IV. Additionally, the replaced left hepatic artery emerged from the left gastric artery and fed into left liver lobe. Conclusions The origination and course of hepatic arterial anatomy should be thoroughly assessed in planning and performing hepatopancreatobiliary surgeries. Reconstruction images of contrast-enhanced CT are helpful to visualize the vascular variations and its spatial relation with adjacent structures.
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Affiliation(s)
- Yong Yan
- Department of General Surgery, Guangzhou Red Cross Hospital, Jinan University, Guangzhou, 510220, China.
| | - Bailin Wang
- Department of General Surgery, Guangzhou Red Cross Hospital, Jinan University, Guangzhou, 510220, China
| | - Wei Yuan
- Department of General Surgery, Guangzhou Red Cross Hospital, Jinan University, Guangzhou, 510220, China
| | - Jiansong Zhang
- The Medical College of Guizhou Medical University, Guiyang, 550025, China
| | - Junhao Xiao
- The Medical College of Guizhou Medical University, Guiyang, 550025, China
| | - Yanhua Sha
- Department of Laboratory Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510120, China.
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2
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Tao W, Peng D, Cheng YX, Zhang W. Clinical significance of aberrant left hepatic artery during gastrectomy: A systematic review. World J Clin Cases 2022; 10:3121-3130. [PMID: 35647120 PMCID: PMC9082717 DOI: 10.12998/wjcc.v10.i10.3121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 12/12/2021] [Accepted: 02/20/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Vascular variations are frequently encountered during surgery. Approximately thirty percent of these variations are aberrant left hepatic arteries originating from the left gastric artery.
AIM To summarize the safety and feasibility of aberrant left hepatic arteries (ALHA) ligation in gastric cancer patients who underwent laparoscopic-assisted gastrectomy (LAG).
METHODS The literature search was systematically performed on databases including PubMed, Embase, and Cochrane Library. The publishing date of eligible studies was from inception to June 2021.
RESULTS A total of nine studies were included according to the inclusion and exclusion criteria in this review. The variation rate of ALHA ranged from 7.00% to 20.70%, and four studies compared the differences between the ALHA ligation group and the preservation group. Only one study showed worse postoperative outcomes in the ALHA ligation group. In all the included studies, a significant difference was found between the ALHA ligation group and the preservation group in terms of postoperative liver enzymes after LAG. However, there was no significant difference in the number of retrieved lymph nodes between the two groups.
CONCLUSION In conclusion, it is not always safe and feasible for surgeons to ligate the ALHA during LAG surgery, and it is necessary for gastric cancer patients to undergo preoperative examination to clarify the ALHA subtypes, measure the diameter of the ALHA, and determine whether the patients have chronic liver disease.
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Affiliation(s)
- Wei Tao
- Department of Gastrointestinal Surgery, the First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Dong Peng
- Department of Gastrointestinal Surgery, the First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Yu-Xi Cheng
- Department of Gastrointestinal Surgery, the First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Wei Zhang
- Department of Gastrointestinal Surgery, the First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
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3
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Hakseven M, Çetindağ Ö, Avşar G, Deryol R, Dokçu Ş, Culcu S, Akbulut S, Bayar S, Ünal AE, Demirci S. Management of Aberrant Left Hepatic Artery During Laparoscopic Gastrectomy and Consequences. J Laparoendosc Adv Surg Tech A 2022; 32:999-1004. [PMID: 35353630 DOI: 10.1089/lap.2022.0005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Introduction: Aberrant left hepatic artery (ALHA) can exist in up to 25% of the population. The presence of ALHA during lymph node (LN) dissection in gastric cancer may complicate the process. In this study, we aimed to evaluate the existence rate, management, and consequences of ALHA in our laparoscopic gastrectomy series. Patients and Methods: Demographical and clinical data of laparoscopically operated 158 consecutive gastric cancer patients were collected retrospectively. Study patients were divided into three groups according to absence, existence and preservation, and existence and sacrification of ALHA. Harvested LN numbers, operation time, and postoperative alanine aminotransferase (ALT), aspartate aminotransferase (AST), and lactate dehydrogenase values on consecutive days were analyzed using Kruskal-Wallis and Mann-Whitney U tests. P < .05 is accepted as significant. Results: The median AST and ALT values of the ALHA-sacrificed group were higher than those of the group without ALHA and the ALHA-preserved group on the 1st, 3rd, and 5th postoperative days (P < .05). On the 10th day, liver enzymes returned to normal values. Conclusion: Adequate and appropriate dissection of LNs while preserving ALHA can be performed without prolonging the operation time. Sacrification of ALHA causes an increase in liver enzymes, with spontaneous recovery in most cases.
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Affiliation(s)
- Musluh Hakseven
- Ankara University Faculty of Medicine, Department of Surgical Oncology, Ankara, Turkey
| | - Özhan Çetindağ
- Ankara University Faculty of Medicine, Department of Surgical Oncology, Ankara, Turkey
| | - Gökhan Avşar
- Ankara University Faculty of Medicine, Department of Surgical Oncology, Ankara, Turkey
| | - Rıza Deryol
- Ankara University Faculty of Medicine, Department of Surgical Oncology, Ankara, Turkey
| | - Şeref Dokçu
- Department of General Surgery, Diyarbakir Gazi Yasargil Education and Research Hospital, Diyarbakir, Turkey
| | - Serdar Culcu
- Ankara University Faculty of Medicine, Department of Surgical Oncology, Ankara, Turkey
| | - Serkan Akbulut
- Ankara University Faculty of Medicine, Department of Surgical Oncology, Ankara, Turkey
| | - Sancar Bayar
- Ankara University Faculty of Medicine, Department of Surgical Oncology, Ankara, Turkey
| | - Ali Ekrem Ünal
- Ankara University Faculty of Medicine, Department of Surgical Oncology, Ankara, Turkey
| | - Salim Demirci
- Ankara University Faculty of Medicine, Department of Surgical Oncology, Ankara, Turkey
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4
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Urabe M, Haruta S, Ueno M. Coexistence of aberrant left hepatic artery and duplicated left gastric artery: a potential surgical pitfall. ANZ J Surg 2021; 92:1551-1552. [PMID: 34698425 DOI: 10.1111/ans.17332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 10/10/2021] [Accepted: 10/14/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Masayuki Urabe
- Department of Gastroenterological Surgery, Toranomon Hospital, Tokyo, Japan
| | - Shusuke Haruta
- Department of Gastroenterological Surgery, Toranomon Hospital, Tokyo, Japan
| | - Masaki Ueno
- Department of Gastroenterological Surgery, Toranomon Hospital, Tokyo, Japan
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Gojayev A, Yüksel C, mercan Ü, Çaparlar MA, Cetindag O, Akbulut S, Ünal AE, Bayar S, Demirci S. The effect and clinical significance of using nathanson
liver retractor on liver function tests in laparoscopic
gastric cancer surgery. POLISH JOURNAL OF SURGERY 2021; 94:54-61. [DOI: 10.5604/01.3001.0015.3544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
ABSTRACT
Aim: There are very few studies in the literature investigating the changes caused by the Nathanson retractors in liver function tests (LFT) after LG and its clinical significance. The present study investigated the changes made by the Nathanson retractor used during LG on LFT and its clinical significance.
Material and Method: The data of 236 patients, who underwent radical gastrectomy for primary gastric cancer at Surgical Oncology Unit in the period between January 2015 and January 2020 were retrospective studied. The patients were divided into two groups: laparoscopic gastrectomy (LG; 136 cases) and open gastrectomy (OG; 106 cases). Patients who have undergone cholecystectomy, with primary or secondary liver tumors, with chronic hepatic disease, who have preoperative high ALT, AST and bilirubin values were excluded from the study. LFT were measured preoperatively and postoperative day 1 (LFT1), LFT3, LFT5 and LFT7. LFT: ALT, AST and Total bilirubin (BIL).
Results: ALT1, ALT3, ALT5, ALT7 ALT values and AST1, AST3, AST5 AST values of the patients in the LG group were found to be significantly higher (P <0.001). Mean total bilirubin values of the groups were similar (P >0.05). In order to evaluate how the increase in LFT due to the use of the Nathanson retractors reflected on the patients' clinic, we divided the patients who underwent LG into two groups based on ALT increase in ALT1: Normal and Elevated. The in-hospital mortality rates (P = 0.080) and oral nutrition time (P = 0.913) of the groups were similar. No liver infarction developed in any of the groups. The duration of stay in the ICU was significantly longer in individuals with elevated LFT (P = 0.019).
Conclusion: Although the use of the Nathanson retractor during LG causes an increase in liver function tests, this does not cause major clinical problems in patients.
Key Words: Gastrectomy; gastric cancer; laparoscopy; liver enzymes; liver dysfunciton
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Affiliation(s)
- Afig Gojayev
- Clinic of Surgical Oncology, Department of General Surgery, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Cemil Yüksel
- Clinic of Surgical Oncology, University of Health Sciences, Ankara Oncology Training and Research Hospital, Ankara, Turkey
| | - ümit mercan
- Department of General Surgery, Clinic of Surgical Oncology, School of Medicine, Ankara University, Turkey
| | - Mehmet Ali Çaparlar
- Clinic of Surgical Oncology, Department of General Surgery, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Ozhan Cetindag
- Clinic of Surgical Oncology, Department of General Surgery, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Serkan Akbulut
- Clinic of Surgical Oncology, Department of General Surgery, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Ali Ekrem Ünal
- Clinic of Surgical Oncology, Department of General Surgery, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Sancar Bayar
- Clinic of Surgical Oncology, Department of General Surgery, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Salim Demirci
- Clinic of Surgical Oncology, Department of General Surgery, Faculty of Medicine, Ankara University, Ankara, Turkey
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Sano A, Saito K, Kuriyama K, Nakazawa N, Ubukata Y, Hara K, Sakai M, Ogata K, Fukasawa T, Sohda M, Fukuchi M, Naitoh H, Shirabe K, Saeki H. Risk Factors for Postoperative Liver Enzyme Elevation After Laparoscopic Gastrectomy for Gastric Cancer. In Vivo 2021; 35:1227-1234. [PMID: 33622925 DOI: 10.21873/invivo.12373] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Revised: 01/15/2021] [Accepted: 01/21/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND/AIM Laparoscopic gastrectomy (LG) is more frequently associated with postoperative liver enzyme elevation (PLEE) than open gastrectomy in phase III clinical trials for Japanese gastric cancer patients. The aim of this study was to determine the risk factors for PLEE after LG for gastric cancer. PATIENTS AND METHODS This study enrolled 153 consecutive patients with gastric cancer who underwent LG. The patient characteristics, the liver retraction method [silicone disc (SD) or Nathanson liver retractor (NLR)], and perioperative outcomes were compared between patients with and without PLEE. RESULTS PLEE was observed in 26 patients (17%). The patients with PLEE exhibited longer operative times (p=0.005) and more frequent use of the NLR for liver retraction (p=0.022). In the multivariate analysis, liver retraction using the NLR (p=0.003) and aberrant left hepatic artery (ALHA) ligation (p=0.042) were independent risk factors of PLEE. CONCLUSION Liver retraction with the SD during LG was shown to be the safer method that is less likely to cause postoperative liver dysfunction. ALHA preservation may contribute to avoiding postoperative liver dysfunction.
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Affiliation(s)
- Akihiko Sano
- Department of General Surgical Science, Gunma University Graduate School of Medicine, Gunma, Japan;
| | - Kana Saito
- Department of Surgery, Japan Community Healthcare Organization Gunma Central Hospital, Gunma, Japan
| | - Kengo Kuriyama
- Department of General Surgical Science, Gunma University Graduate School of Medicine, Gunma, Japan
| | - Nobuhiro Nakazawa
- Department of General Surgical Science, Gunma University Graduate School of Medicine, Gunma, Japan
| | - Yasunari Ubukata
- Department of General Surgical Science, Gunma University Graduate School of Medicine, Gunma, Japan
| | - Keigo Hara
- Department of General Surgical Science, Gunma University Graduate School of Medicine, Gunma, Japan
| | - Makoto Sakai
- Department of General Surgical Science, Gunma University Graduate School of Medicine, Gunma, Japan
| | - Kyoichi Ogata
- Department of General Surgical Science, Gunma University Graduate School of Medicine, Gunma, Japan
| | - Takaharu Fukasawa
- Department of Surgery, Japan Community Healthcare Organization Gunma Central Hospital, Gunma, Japan
| | - Makoto Sohda
- Department of General Surgical Science, Gunma University Graduate School of Medicine, Gunma, Japan
| | - Minoru Fukuchi
- Department of Surgery, Japan Community Healthcare Organization Gunma Central Hospital, Gunma, Japan
| | - Hiroshi Naitoh
- Department of Surgery, Japan Community Healthcare Organization Gunma Central Hospital, Gunma, Japan
| | - Ken Shirabe
- Department of General Surgical Science, Gunma University Graduate School of Medicine, Gunma, Japan
| | - Hiroshi Saeki
- Department of General Surgical Science, Gunma University Graduate School of Medicine, Gunma, Japan
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7
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Lee S, Son T, Song JH, Choi S, Cho M, Kim YM, Kim HI, Hyung WJ. Adverse Effects of Ligation of an Aberrant Left Hepatic Artery Arising from the Left Gastric Artery during Radical Gastrectomy for Gastric Cancer: a Propensity Score Matching Analysis. J Gastric Cancer 2021; 21:74-83. [PMID: 33854815 PMCID: PMC8020005 DOI: 10.5230/jgc.2021.21.e6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 03/12/2021] [Accepted: 03/12/2021] [Indexed: 12/14/2022] Open
Abstract
PURPOSE No consensus exists on whether to preserve or ligate an aberrant left hepatic artery (ALHA), which is the most commonly encountered hepatic arterial variation during gastric surgery. Therefore, we aimed to evaluate the clinical effects of ALHA ligation by analyzing the perioperative outcomes. MATERIALS AND METHODS We retrospectively reviewed the data of 5,310 patients who underwent subtotal/total gastrectomy for gastric cancer. Patients in whom the ALHA was ligated (n=486) were categorized into 2 groups according to peak aspartate aminotransferase (AST) or alanine aminotransferase (ALT) levels: moderate-to-severe (MS) elevation (≥5 times the upper limit of normal [ULN]; MS group, n=42) and no-to-mild (NM) elevation (<5 times the ULN; NM group, n=444). The groups were matched 1:3 using propensity score-matching analysis to minimize confounding factors that can affect the perioperative outcomes. RESULTS The mean operation time (P=0.646) and blood loss amount (P=0.937) were similar between the 2 groups. The length of hospital stay was longer in the MS group (13.0 vs. 7.8 days, P=0.022). No postoperative mortality occurred. The incidence of grade ≥ IIIa postoperative complications (19.0% vs. 5.1%, P=0.001), especially pulmonary complications (11.9% vs. 2.5%, P=0.003), was significantly higher in the MS group. This group also showed a higher Comprehensive Complication Index (29.0 vs. 13.9, P<0.001). CONCLUSIONS Among patients with a ligated ALHA, those with peak AST/ALT ≥5 times the ULN showed worse perioperative outcomes in terms of hospital stay and severity of complications. More precise perioperative decision-making tools are needed to better determine whether to preserve or ligate an ALHA.
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Affiliation(s)
- Sejin Lee
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
- Gastric Cancer Center, Yonsei Cancer Center, Yonsei University Health System, Seoul, Korea
| | - Taeil Son
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
- Gastric Cancer Center, Yonsei Cancer Center, Yonsei University Health System, Seoul, Korea
| | - Jeong Ho Song
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
- Gastric Cancer Center, Yonsei Cancer Center, Yonsei University Health System, Seoul, Korea
| | - Seohee Choi
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
- Gastric Cancer Center, Yonsei Cancer Center, Yonsei University Health System, Seoul, Korea
| | - Minah Cho
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
- Gastric Cancer Center, Yonsei Cancer Center, Yonsei University Health System, Seoul, Korea
| | - Yoo Min Kim
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
- Gastric Cancer Center, Yonsei Cancer Center, Yonsei University Health System, Seoul, Korea
| | - Hyoung-Il Kim
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
- Gastric Cancer Center, Yonsei Cancer Center, Yonsei University Health System, Seoul, Korea
| | - Woo Jin Hyung
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
- Gastric Cancer Center, Yonsei Cancer Center, Yonsei University Health System, Seoul, Korea
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Real-time identification of aberrant left hepatic arterial territories using near-infrared fluorescence with indocyanine green during gastrectomy for gastric cancer. Surg Endosc 2021; 35:2389-2397. [PMID: 33492510 DOI: 10.1007/s00464-020-08265-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 12/22/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND An aberrant left hepatic artery is frequently encountered during upper gastrointestinal surgery, and researchers have yet to propose optimal strategies with which to address this arterial variation. The objective of this study was to determine whether the areas perfused by an aberrant left hepatic artery can be visualized in real-time using near-infrared fluorescence imaging with indocyanine green. METHODS Patients with gastric adenocarcinoma who underwent minimally invasive radical gastrectomy from May 2018 to August 2019 were enrolled and retrospectively analyzed at a single-center. Patients with an aberrant left hepatic artery and normal preoperative liver function were examined. After the clamping of an aberrant left hepatic artery, indocyanine green was administered via a peripheral intravenous route during surgery. Fluorescence at the liver was visualized under near-infrared fluorescence imaging. RESULTS In 31 patients with aberrant left hepatic arteries, near-infrared fluorescence imaging was used without adverse events associated with indocyanine green. Six (19%) patients were reported to have an aberrant left hepatic artery upon preoperative CT imaging, while all other instances were detected during surgery. Fluorescence excitation on the liver was, on average, visible after 43 s (range, 25-65). Fluorescence across the entire surface of the liver was noted in 20 (65%) patients in whom the aberrant left hepatic artery could be ligated. Aberrant left hepatic arteries were safely preserved in 10 (32%) patients who showed areas of no or partial fluorescence excitation. Guided by near-infrared fluorescence imaging, ligation of aberrant left hepatic arteries elicited no significant changes in postoperative liver function. CONCLUSION Near-infrared fluorescence imaging facilitates the identification of aberrant left hepatic arterial territories, guiding decisions on the preservation or ligation of this arterial variation.
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Preserving a Replaced Left Hepatic Artery Arising from the Left Gastric Artery During Laparoscopic Distal Gastrectomy for Gastric Cancer. World J Surg 2020; 45:543-553. [PMID: 33108491 DOI: 10.1007/s00268-020-05832-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/11/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND A replaced left hepatic artery (RLHA) arising from the left gastric artery (LGA) is occasionally encountered during laparoscopic gastrectomy. Although the RLHA is usually divided at the root level as RLHA preservation might result in inadequate lymph node dissection, blood flow disruption by RLHA division may lead to hepatic ischemia. To date, there is no consensus on RLHA preservation. Thus, we aimed to evaluate the efficacy of RLHA preservation by investigating the short-term outcomes of patients with RLHA who underwent laparoscopic distal gastrectomy (LDG). METHODS A total of 106 patients with an aberrant LHA from the LGA were identified as having gastric cancer and underwent LDG from 2012 to 2018. Finally, 55 patients were retrospectively diagnosed with RLHA by preoperative computed tomography and included in this study. Patients were classified into the divided (n = 18) or preserved (n = 37) group. Clinicopathological factors and surgical outcomes were compared between the two groups. RESULTS The RLHA preservation rate in patients who had been preoperatively diagnosed with RLHA was 88%. No significant difference was found in the number of harvested lymph nodes between the groups. The incidence of hepatic infarction was significantly higher in the divided group (16.7% vs. 0%, p = 0.031). Moreover, RLHA division caused postoperative transaminase elevation and was an independent risk factor for postoperative transaminase elevation (odds ratio: 55.8, p < 0.001). CONCLUSIONS Surgical procedures of RLHA preservation reduced postoperative transaminase elevation and hepatic infarction in patients who underwent LDG. Surgeons should confirm the RLHA preoperatively and preserve it to prevent hepatic damage.
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10
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Ang RRG, Lee HJ, Bae JS, Zhu CC, Berlth F, Kim TH, Park SH, Suh YS, Kong SH, Kim SH, Yang HK. Safety of Ligation of Aberrant Left Hepatic Artery Originating from Left Gastric Artery in Laparoscopic Gastrectomy for Gastric Cancer. Sci Rep 2020; 10:5856. [PMID: 32246010 PMCID: PMC7125141 DOI: 10.1038/s41598-020-62587-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Accepted: 02/26/2020] [Indexed: 02/07/2023] Open
Abstract
There are still lot of controversies whether aberrant left hepatic artery (ALHA) originating from left gastric artery should be ligated or preserved during gastric cancer (GC) surgery. We aimed to investigate this issue. We reviewed ALHA cases who had laparoscopic gastrectomy for gastric cancer at Seoul National University Hospital (SNUH) from 2012 to 2016. Type of ALHA variants using Michel's classification of hepatic arterial anatomy and diameter of each vessel were evaluated by 2 radiologists. Postoperative hepatic function and surgical outcome were collected until 6 months after surgery. Results showed that if the diameter of ALHA was larger than 1.5 mm, a transient elevation of SGOT and SGPT on postoperative day 2 was observed in the ligated cases. No differences were observed in operation time, amount of blood loss, overall complication rate, hospital stay, and number of lymph nodes retrieved between the ligated and preserved replaced left hepatic artery (RLHA) and accessory left hepatic artery (acLHA) group. In this study, we conclude that ligation of ALHA seems to be safe as none of the patients suffered adverse outcome. A transient rise in postoperative SGOT and SGPT levels were seen after ligating ALHA >1.5 mm in diameter regardless of subtype.
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Affiliation(s)
- Rene Ronson G Ang
- Department of Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
- Department of Surgery, Cebu Doctors' University Hospital, Cebu City, Philippines
- Department of Surgery, University of Cebu Medical Center, Cebu City, Philippines
| | - Hyuk-Joon Lee
- Department of Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea.
| | - Jae Seok Bae
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
| | - Chun-Chao Zhu
- Department of Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
- Department of Gastrointestinal Surgery, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Felix Berlth
- Department of Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
- Department of General, Visceral and Cancer Surgery, University of Cologne, Köln, Germany
| | - Tae Han Kim
- Department of Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
- Department of Surgery, Gyeongsang National University Changwon Hospital, Changwon, Korea
| | - Shin-Hoo Park
- Department of Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Yun-Suhk Suh
- Department of Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Seong-Ho Kong
- Department of Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Se Hyung Kim
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
| | - Han-Kwang Yang
- Department of Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
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11
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Aberrant left hepatic arteries arising from left gastric arteries and their clinical importance. Surgeon 2019; 18:100-112. [PMID: 31337536 DOI: 10.1016/j.surge.2019.06.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 06/13/2019] [Accepted: 06/26/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND The Aberrant Left Hepatic Artery (ALHA) is replaced when it does not originate from the hepatic artery proper and it is the only supply to that part of the liver, while an accessory artery coexists with a normal artery. The aim of this systematic review is to evaluate the incidence of ALHAs including the one arising from the Left Gastric Artery, also named Hyrtl's artery. METHODS A literature search in PubMed, SCOPUS, WOS and Google Scholar was performed. The risk of bias was assessed by means of the AQUA tool. The main outcome was the prevalence of ALHA. Secondary outcomes were the prevalence of the accessory and replaced left hepatic arteries. A subgroup analysis was conducted by geographic region and type of evaluation. RESULTS This review included 57 studies, with a total of 19,284 patients. The majority of the studies involved the use of radiological techniques -especially Angio-CT-and were performed in Asia. The overall risk of bias was moderate. The overall prevalence of the ALHA was 13.52%; the overall prevalence was 8.26% for the Replaced ALHA and 5.55% for the Accessory ALHA. In the 18 studies that employed Michels' classification, Type II had the lowest prevalence (0.36%) and Type VII the highest prevalence (6.62%). DISCUSSION Some of the studies included did not distinguish between the ''replaced'' and ''accessory'' ALHA (34.25%). Some surgical dissection techniques proved insufficient for the localization of other hepatic arteries. These results suggest that an accurate preoperative radiological evaluation is needed to localize replaced arteries.
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12
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Cirocchi R, D'Andrea V, Lauro A, Renzi C, Henry BM, Tomaszewski KA, Rende M, Lancia M, Carlini L, Gioia S, Randolph J. The absence of the common hepatic artery and its implications for surgical practice: Results of a systematic review and meta-analysis. Surgeon 2019; 17:172-185. [DOI: 10.1016/j.surge.2019.03.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 01/22/2019] [Accepted: 03/05/2019] [Indexed: 02/06/2023]
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13
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Clinical evaluation of the aberrant left hepatic artery arising from the left gastric artery in esophagectomy. Surg Radiol Anat 2018; 40:749-756. [DOI: 10.1007/s00276-018-2022-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Accepted: 04/09/2018] [Indexed: 12/11/2022]
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Yamamoto M, Zaima M, Yamamoto H, Harada H, Kawamura J, Yamada M, Yazawa T, Kawasoe J. Liver necrosis shortly after pancreaticoduodenectomy with resection of the replaced left hepatic artery. World J Surg Oncol 2017; 15:77. [PMID: 28399882 PMCID: PMC5387288 DOI: 10.1186/s12957-017-1151-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Accepted: 04/02/2017] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Surgeons, in general, underestimate the replaced left hepatic artery (rLHA) that arises from the left gastric artery (LGA), compared with the replaced right hepatic artery (rRHA), especially in standard gastric cancer surgery. During pancreaticoduodenectomy (PD), preservation of the rRHA arising from the superior mesenteric artery (SMA) is widely accepted to prevent critical postoperative complications, such as liver necrosis, bile duct ischemia, and biliary anastomotic leakage. In contrast, details of complication onset following rLHA resection remain unknown. We report two cases of postoperative liver necrosis shortly after rLHA resection during PD for advanced gastric cancer. CASE PRESENTATION Both cases had advanced gastric cancer with infiltration of the pancreatic head. In case 1, the rLHA comprised segment 2/3 artery (A2 + A3), which arose from the LGA. The rRHA originated from the SMA, and the segment 4 artery (A4) was a branch of the rRHA. We conducted PD with combined en bloc resection of both the rLHA and rRHA, and anastomosis between the distal and proximal stumps of the rRHA and LGA, respectively. The divided A2 + A3 was not reconstructed. In case 2, the rLHA comprised segment 2 artery (A2) only, which arose from the LGA. The segment 3/4 artery and the RHAs originated from the proper hepatic artery. We undertook PD with combined en bloc resection of A2 without vascular reconstruction. In both patients, serious necrosis of the lateral segment of the liver occurred within 6 days after PD. Case 1 recovered with conservative management, whereas case 2 required lateral segmentectomy of the liver. Pathologically, the necrotic area in case 2 was apparently circumscribed and confined to segment 2 of the liver, potentially implicating rLHA resection during PD as causing hepatic necrosis. CONCLUSIONS During PD, rLHA resection can cause serious liver necrosis. Therefore, this artery should be preserved as far as oncologically acceptable. In cases that require rLHA resection during PD due to tumor conditions, surgeons should carefully monitor postoperative course while keeping in mind the possible necessity of urgent hepatectomy.
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Affiliation(s)
- Michihiro Yamamoto
- Shiga Medical Center for Adults, 4-30 Moriyama 5-chome, Moriyama city, Shiga Prefecture, 524-8524, Japan.
| | - Masazumi Zaima
- Shiga Medical Center for Adults, 4-30 Moriyama 5-chome, Moriyama city, Shiga Prefecture, 524-8524, Japan
| | - Hidekazu Yamamoto
- Shiga Medical Center for Adults, 4-30 Moriyama 5-chome, Moriyama city, Shiga Prefecture, 524-8524, Japan
| | - Hideki Harada
- Shiga Medical Center for Adults, 4-30 Moriyama 5-chome, Moriyama city, Shiga Prefecture, 524-8524, Japan
| | - Junichiro Kawamura
- Shiga Medical Center for Adults, 4-30 Moriyama 5-chome, Moriyama city, Shiga Prefecture, 524-8524, Japan
| | - Masahiro Yamada
- Shiga Medical Center for Adults, 4-30 Moriyama 5-chome, Moriyama city, Shiga Prefecture, 524-8524, Japan
| | - Tekefumi Yazawa
- Shiga Medical Center for Adults, 4-30 Moriyama 5-chome, Moriyama city, Shiga Prefecture, 524-8524, Japan
| | - Junya Kawasoe
- Shiga Medical Center for Adults, 4-30 Moriyama 5-chome, Moriyama city, Shiga Prefecture, 524-8524, Japan
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Yuasa Y, Okitsu H, Goto M, Kuramoto S, Tomibayashi A, Matsumoto D, Edagawa H, Mori O, Tani R, Akagawa T, Kinoshita M, Akagawa Y, Tani H, Ohnishi N, Shirono R. Three-dimensional CT for preoperative detection of the left gastric artery and left gastric vein in laparoscopy-assisted distal gastrectomy. Asian J Endosc Surg 2016; 9:179-85. [PMID: 27122447 DOI: 10.1111/ases.12280] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2014] [Revised: 01/21/2016] [Accepted: 02/01/2016] [Indexed: 12/26/2022]
Abstract
INTRODUCTION We evaluated 3-D CT imaging for preoperative classification of the left gastric artery and vein in patients with early gastric cancer and estimated its clinical benefit. METHODS Between April 2009 and March 2014, 279 patients underwent preoperative 3-D CT using a 64-row multi-detector CT scanner, followed by laparoscopy-assisted distal gastrectomy. The 3-D CT images of the arterial and portal phases were reconstructed and fused. The operative outcomes were compared between patients who had not undergone 3-D CT (2007-2008) and who had undergone 3-D CT (2009-2011). RESULTS According to Adachi's classification, the numbers of type I, II, III, IV, V, and VI arterial patterns were 253, 15, 1, 3, 3, and 1, respectively. Three cases could not be classified. According to the Douglass classification, the left gastric vein flowed into the portal vein, splenic vein, junction of the portal vein and splenic vein, and left branch of the portal vein in 119, 111, 36, and 5 patients, respectively. The left gastric vein could not be visualized in six patients, and two patients could not be classified. In addition, the relation was absent for an Adachi type I vein and one of the "other" types of veins. The total operative time was significantly shorter with 3-D CT than without it (P = 0.01), and the degree of lymph-node dissection was significantly higher (P = 0.01). Inflammatory parameters and operative morbidity tended to decrease with 3-D CT. CONCLUSION Three-dimensional CT is a useful modality to visualize the vessel anatomy around the stomach, and it improves clinical effectiveness and reduces the invasiveness of surgery.
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Affiliation(s)
- Yasuhiro Yuasa
- Department of Digestive Surgery, Tokushima Red Cross Hospital, Komatsushima City, Japan
| | - Hiroshi Okitsu
- Department of Digestive Surgery, Tokushima Red Cross Hospital, Komatsushima City, Japan
| | - Masakazu Goto
- Department of Digestive Surgery, Tokushima Red Cross Hospital, Komatsushima City, Japan
| | - Shunsuke Kuramoto
- Department of Digestive Surgery, Tokushima Red Cross Hospital, Komatsushima City, Japan
| | - Atsushi Tomibayashi
- Department of Digestive Surgery, Tokushima Red Cross Hospital, Komatsushima City, Japan
| | - Daisuke Matsumoto
- Department of Digestive Surgery, Tokushima Red Cross Hospital, Komatsushima City, Japan
| | - Hiroshi Edagawa
- Department of Digestive Surgery, Tokushima Red Cross Hospital, Komatsushima City, Japan
| | - Osamu Mori
- Department of Digestive Surgery, Tokushima Red Cross Hospital, Komatsushima City, Japan
| | - Ryotaro Tani
- Department of Digestive Surgery, Tokushima Red Cross Hospital, Komatsushima City, Japan
| | - Takuya Akagawa
- Department of Radiology, Tokushima Red Cross Hospital, Komatsushima City, Japan
| | - Mitsuhiro Kinoshita
- Department of Radiology, Tokushima Red Cross Hospital, Komatsushima City, Japan
| | - Yoko Akagawa
- Department of Radiology, Tokushima Red Cross Hospital, Komatsushima City, Japan
| | - Hayato Tani
- Department of Radiology, Tokushima Red Cross Hospital, Komatsushima City, Japan
| | - Norio Ohnishi
- Department of Radiology, Tokushima Red Cross Hospital, Komatsushima City, Japan
| | - Ryozo Shirono
- Department of Radiology, Tokushima Red Cross Hospital, Komatsushima City, Japan
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16
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Kim J, Kim SM, Seo JE, Ha MH, An JY, Choi MG, Lee JH, Bae JM, Kim S, Jeong WK, Sohn TS. Should an Aberrant Left Hepatic Artery Arising from the Left Gastric Artery Be Preserved during Laparoscopic Gastrectomy for Early Gastric Cancer Treatment? J Gastric Cancer 2016; 16:72-7. [PMID: 27433391 PMCID: PMC4944005 DOI: 10.5230/jgc.2016.16.2.72] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Revised: 03/22/2016] [Accepted: 04/02/2016] [Indexed: 12/11/2022] Open
Abstract
Purpose During laparoscopic gastrectomy, an aberrant left hepatic artery (ALHA) arising from the left gastric artery (LGA) is occasionally encountered. The aim of this study was to define when an ALHA should be preserved during laparoscopic gastrectomy. Materials and Methods From August 2009 to December 2014, 1,340 patients with early gastric cancer underwent laparoscopic distal gastrectomy. One hundred fifty patients presented with an ALHA; of the ALHA was ligated in 116 patients and preserved in 34 patients. Patient characteristics, postoperative outcomes and perioperative liver function tests were reviewed retrospectively. Correlations between the diameter of the LGA measured on preoperative abdominal computed tomography and postoperative liver enzyme levels were analyzed. Results Pearson's correlation analysis showed a positive correlation between the diameter of the LGA and serum aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels on postoperative day 1 in the ALHA-ligated group (P=0.039, P=0.026, respectively). Linear regression analysis estimated the diameter of the LGA to be 5.1 mm and 4.9 mm when AST and ALT levels were twice the normal limit on postoperative day 1. Conclusions We suggest preserving the ALHA arising from a large LGA, having diameter greater than 5 mm, during laparoscopic gastrectomy to prevent immediate postoperative hepatic dysfunction.
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Affiliation(s)
- Jieun Kim
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Su Mi Kim
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jeong Eun Seo
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Man Ho Ha
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ji Yeong An
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Min Gew Choi
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jun Ho Lee
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jae Moon Bae
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sung Kim
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Woo Kyoung Jeong
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Tae Sung Sohn
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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17
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Kuwada K, Kuroda S, Kikuchi S, Hori N, Kubota T, Nishizaki M, Kagawa S, Fujiwara T. Strategic approach to concurrent aberrant left gastric vein and aberrant left hepatic artery in laparoscopic distal gastrectomy for early gastric cancer: A case report. Asian J Endosc Surg 2015; 8:454-6. [PMID: 26708584 PMCID: PMC5064726 DOI: 10.1111/ases.12203] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Revised: 05/08/2015] [Accepted: 06/01/2015] [Indexed: 12/16/2022]
Abstract
An aberrant left gastric vein (ALGV) directly entering the lateral segment of the liver is a rare variation in the portal vein system, whereas an aberrant left hepatic artery (ALHA) arising from the left gastric artery is observed relatively frequently. Here we report a case in which both ALGV and ALHA were encountered before laparoscopic distal gastrectomy with curative lymphadenectomy for gastric cancer. We accurately diagnosed these vessel anomalies preoperatively on abdominal contrast-enhanced CT. During surgery, we divided the ALGV at the point of entry to the liver and preserved the ALHA by dividing the branches toward the stomach, in consideration of curability and safety. The postoperative course was uneventful overall, although temporary mild liver dysfunction was observed. This case highlights the importance of preoperative evaluation and preparation in a rare case of concurrent ALGV and ALHA.
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Affiliation(s)
- Kazuya Kuwada
- Department of Gastroenterological Surgery, Dentistry and Pharmaceutical SciencesOkayama University Graduate School of MedicineOkayamaJapan
| | - Shinji Kuroda
- Department of Gastroenterological Surgery, Dentistry and Pharmaceutical SciencesOkayama University Graduate School of MedicineOkayamaJapan
| | - Satoru Kikuchi
- Department of Gastroenterological Surgery, Dentistry and Pharmaceutical SciencesOkayama University Graduate School of MedicineOkayamaJapan
| | - Naoto Hori
- Department of Gastroenterological Surgery, Dentistry and Pharmaceutical SciencesOkayama University Graduate School of MedicineOkayamaJapan
| | - Tetsushi Kubota
- Department of Gastroenterological Surgery, Dentistry and Pharmaceutical SciencesOkayama University Graduate School of MedicineOkayamaJapan
| | - Masahiko Nishizaki
- Department of Gastroenterological Surgery, Dentistry and Pharmaceutical SciencesOkayama University Graduate School of MedicineOkayamaJapan
| | - Shunsuke Kagawa
- Department of Gastroenterological Surgery, Dentistry and Pharmaceutical SciencesOkayama University Graduate School of MedicineOkayamaJapan
| | - Toshiyoshi Fujiwara
- Department of Gastroenterological Surgery, Dentistry and Pharmaceutical SciencesOkayama University Graduate School of MedicineOkayamaJapan
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18
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Huang CM, Chen RF, Chen QY, Wei J, Zheng CH, Li P, Xie JW, Wang JB, Lin JX, Lu J, Cao LL, Lin M. Application Value of a 6-Type Classification System for Common Hepatic Artery Absence During Laparoscopic Radical Resections for Gastric Cancer: A Large-Scale Single-Center Study. Medicine (Baltimore) 2015; 94:e1280. [PMID: 26266363 PMCID: PMC4616714 DOI: 10.1097/md.0000000000001280] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
The common hepatic artery (CHA) is an important blood vessel that must be vascularized during D2 lymphadenectomies for gastric cancer. When the CHA is absent, the risk of vascular injury increases.To explore the anatomic classification of CHA absence and its application value in laparoscopic radical resections for gastric cancer.Clinical data were collected prospectively from 2170 gastric cancer patients from June 2007 to December 2013, and the data were analyzed retrospectively. The anatomy of CHA absence was assessed synthetically by combining preoperative CT scans and intraoperative images, which were classified according to the anatomy of replaced hepatic arteries (RHAs) and were grouped into the early-year group (2007-2011) and the later-year group (2012-2013) based on the year in which the operation was performed.CHA absence was noted in 38 cases (1.8%) and was classified into 6 types: type I (replaced CHA [RCHA] from the superior mesenteric artery [SMA] with retropancreatic course, 28), type II (RCHA from the SMA with circumambulated course, 1), type III (RCHA from the aortic artery, 1), type IV (replaced left hepatic artery [RLHA] from the left gastric artery [LGA] and replaced right hepatic artery [RRHA] from the SMA, 5), type V (RLHA from the LGA and RRHA from the celiac artery, 2), and type VI (RLHA from the aberrant gastroduodenal artery and RRHA from the SMA, 1). Of the 38 cases, 17 cases (44.7%) belong to the early-year group, and 21 cases (55.3%) belong to the later-year group. The vascular injury rate was significantly lower in the later-year group than in the early-year group (4.8% [1/21] vs 41.2% [7/17], P = 0.005]. Additionally, the alanine aminotransferase (ALT), aspartate aminotransferase (AST), and total bilirubin (TBIL) values were significantly lower in the later-year group than in the early-year group on postoperative day 3 (all P < 0.05).A 6-type anatomic classification system can be used to demonstrate variations in features resulting from CHA absence in detail. Knowledge regarding a patient's classification is helpful for surgeons, and vascular injury and liver function damage may be reduced in patients who are properly classified prior to surgery.
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Affiliation(s)
- Chang-Ming Huang
- From the Department of Gastric Surgery (C-MH, R-FC, Q-YC, C-HZ, PL, J-WX, J-BW, J-XL, JL, L-LC, ML); and Department of CT/MR, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China (JW)
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19
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Mu GC, Huang Y, Liu ZM, Lin JL, Zhang LL, Zeng YJ. Clinical research in individual information of celiac artery CT imaging and gastric cancer surgery. Clin Transl Oncol 2013; 15:774-9. [PMID: 23359186 DOI: 10.1007/s12094-013-1002-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2012] [Accepted: 01/03/2013] [Indexed: 12/18/2022]
Abstract
OBJECTIVE The objective of this study is to acquire CT images of the celiac artery by 64-multi-slice spiral CT angiography (64-MSCTA) in gastric cancer patients to facilitate gastric cancer surgery. METHODS Preoperative 64-MSCTA was performed to observe the origin, course and anatomical variations of the celiac artery and vascular calcifications in 102 gastric cancer patients. RESULTS (1) The celiac trunk mostly arose at the level between the 12th thoracic vertebra and the 1st lumbar vertebra; the mean inferior angle with the abdominal aorta was 63.5° (14°-159°), the mean length was 36.29 mm (5.80-73.58 mm), and its course showed many styles. (2) Of 102 gastric cancer patients, 34 patients (33.33 %) were observed with celiac artery variations of whom there were 27 patients with anatomical variations of the hepatic artery, 3 patients with anatomical variation of the left gastric artery and 1 patient with anatomical variation of the splenic artery; in 1 patient, the celiac trunk and the superior mesenteric artery originated from a common trunk. In other cases, it was observed with another variation. (3) The abdominal aortic calcified plaque was observed in 48 patients (47.1 %), and among them, 34 patients were more than 60 years old, and the existence of the abdominal aortic calcified plaque was related to age, significantly (P < 0.01). CONCLUSIONS The 64-MSCTA largely improves our understanding of the origin, course and anatomical variations of the celiac artery and vascular calcifications in individual patient with gastric cancer. It is recommended that the 64-MSCTA of the celiac artery should be classified as a routine preoperative procedure in gastric cancer patients.
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Affiliation(s)
- G C Mu
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, China
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20
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Elevation of Liver Function Tests After Laparoscopic Gastrectomy Using a Nathanson Liver Retractor. World J Surg 2011; 35:2730-8. [DOI: 10.1007/s00268-011-1301-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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21
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Oki E, Sakaguchi Y, Hiroshige S, Kusumoto T, Kakeji Y, Maehara Y. Preservation of an aberrant hepatic artery arising from the left gastric artery during laparoscopic gastrectomy for gastric cancer. J Am Coll Surg 2011; 212:e25-7. [PMID: 21398157 DOI: 10.1016/j.jamcollsurg.2011.01.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2010] [Revised: 01/05/2011] [Accepted: 01/11/2011] [Indexed: 12/14/2022]
Affiliation(s)
- Eiji Oki
- Department of Surgery, National Beppu Medical Center, Beppu, Japan.
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22
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Technique of minimally invasive Ivor Lewis esophagectomy. Ann Thorac Surg 2010; 89:S2159-62. [PMID: 20494002 DOI: 10.1016/j.athoracsur.2010.03.069] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2010] [Revised: 03/11/2010] [Accepted: 03/12/2010] [Indexed: 12/19/2022]
Abstract
Since the initial description of laparoscopic fundoplication, surgeons have increasingly incorporated the techniques of minimally invasive surgery in the surgical management of esophageal diseases. Minimally invasive surgical techniques have been more frequently applied for benign esophageal disease, and are now being used for malignant disease. There are several approaches, which include the transthoracic and transhiatal approaches, for esophageal resection for cancer. The objective of this article is to describe our technique of minimally invasive Ivor Lewis esophagectomy.
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Mesenteric arterial variations detected at MDCT angiography of abdominal aorta. AJR Am J Roentgenol 2009; 192:1097-102. [PMID: 19304720 DOI: 10.2214/ajr.08.1532] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purposes of this essay are to outline MDCT angiographic techniques for the evaluation of the mesenteric arterial vasculature and to review anatomic variants depicted on MDCT angiograms. CONCLUSION MDCT angiography has distinct advantages over conventional angiography in imaging of the mesenteric arterial vasculature.
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Yamashita H, Yoshimi F, Mori K, Mochizuki Y, Nagai H, Ikeda H, Shioyama Y, Yamada K. Replacement of the common hepatic artery by the left gastric artery: a rare variant in gastric cancer surgery. Eur J Surg Oncol 2008; 34:943-944. [PMID: 18378111 DOI: 10.1016/j.ejso.2008.02.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2008] [Accepted: 02/18/2008] [Indexed: 11/17/2022] Open
Affiliation(s)
- H Yamashita
- Department of Surgery, Ibaraki Prefectural Central Hospital, 6528 Koibuchi, Kasama-shi, Ibaraki 309-1793, Japan.
| | - F Yoshimi
- Department of Surgery, Ibaraki Prefectural Central Hospital, 6528 Koibuchi, Kasama-shi, Ibaraki 309-1793, Japan
| | - K Mori
- Department of Surgery, Ibaraki Prefectural Central Hospital, 6528 Koibuchi, Kasama-shi, Ibaraki 309-1793, Japan
| | - Y Mochizuki
- Department of Surgery, Ibaraki Prefectural Central Hospital, 6528 Koibuchi, Kasama-shi, Ibaraki 309-1793, Japan
| | - H Nagai
- Department of Surgery, Ibaraki Prefectural Central Hospital, 6528 Koibuchi, Kasama-shi, Ibaraki 309-1793, Japan
| | - H Ikeda
- Department of Radiology, Ibaraki Prefectural Central Hospital, Kasama, Ibaraki, Japan
| | - Y Shioyama
- Department of Radiology, Ibaraki Prefectural Central Hospital, Kasama, Ibaraki, Japan
| | - K Yamada
- Department of Radiology, Ibaraki Prefectural Central Hospital, Kasama, Ibaraki, Japan
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