Anatomical observation and clinical significance of the left gastric vein in laparoscopic radical gastrectomy

Background

The left gastric vein (LGV) plays an important role in laparoscopic radical gastrectomy (LRG). However, the anatomy of the LGV is complicated with significant variation, and it is often damaged and bleeding during LRG. The purpose of this study was to observe and analyze the anatomic types of the LGV in patients undergoing LRG and to explore its clinical significance.

Methods

A total of 217 patients who underwent LRG from June 2016 to December 2020 were included. LGVs were divided into four types according to the relationship between the LGV and peripheral arteries [celiac artery (CA)/common hepatic artery (CHA)/splenic artery (SA)] and the pancreas during LRG. If a LGV was damaged during surgery (resulting in bleeding), it was included in the bleeding group. Non-bleeding groups were included if there was no impairment to the LGV.

Results

A total of four types of LGVs were observed, of which type I was the most prevalent, accounting for 58.8% (n=121). In 21 patients (9.7%), the LGV was injured and hemorrhagic during LRG; and the type IV LGV injury bleeding rate was as high as 41.7% (5/12). Univariate analysis revealed that the extent of lymph node dissection (LND), pathological stage, tumor (T) stage, and type of LGV were significantly associated with LGV injury and hemorrhage (P<0.05). Multivariate analysis showed that enlarged LND, late T stage, late pathological stage, and type IV LGV were independent risk factors for LGV injury hemorrhage.

Conclusions

LGVs that run between the CHA (posterior) and the CA into the portal venous system were the most common anatomical type. A LGV that runs between the SA (posterior) and the CA into the portal venous system is easily injured (resulting in bleeding). LGV injury and hemorrhage are affected by a variety of factors, and therefore, careful intraoperative dissection is necessary to avoid damage to the LGV.