AIM:To investigate celiac artery variations in gastric cancer patients and the impact on gastric cancer surgery, and also to discuss the value of the ultrasonic knife in reducing the risk caused by celiac artery variations. METHODS:A retrospective analysis was conducted to investigate the difference in average operation time, intraoperative blood loss, number of harvested lymph nodes, average postoperative drainage within 3 d, and postoperative hospital stay between the group with vascular variations and no vascular variations, and between the ultrasonic harmonic scalpel and conventional electric scalpel surgery group. RESULTS:One hundred and fifty-eight cases presented with normal celiac artery, and 80 presented with celiac artery variation (33.61%). The average operation time, blood loss, average drainage within 3 d after surgery in the celiac artery variation group were significantly more than in the no celiac artery variation group (215.7 ± 32.7 min vs 204.2 ± 31.3 min, 220.0 ± 56.7 mL vs 163.1 ± 52.3 mL, 193.6 ± 41.4 mL vs 175.3 ± 34.1 mL, respectively, P < 0.05). In celiac artery variation patients, the average operation time, blood loss, average drainage within 3 d after surgery in the ultrasonic harmonic scalpel group were significantly lower than in the conventional electric scalpel surgery group (209.5 ± 34.9 min vs 226.9 ± 29.4 min, 207.5 ± 57.1 mL vs 235.6 ± 52.9 mL, 184.4 ± 38.2 mL vs 205.0 ± 42.9 mL, respectively, P < 0.05), and the number of lymph node dissections was significantly higher than in the conventional surgery group (25.5 ± 9.2 vs 19.9 ± 7.8, P < 0.05). CONCLUSION: Celiac artery variation increases the ORIGINAL ARTICLE Study of celiac artery variations and related surgical techniques in gastric cancerand the effect of vascular variation on gastric cancer surgery outcome among 238 patients receiving radical gastrectomy, meanwhile addressing the efficacy of ultrasound harmonic scalpel in minimizing risk due to vascular variation, so as to provide a reference for guiding gastric cancer treatment in clinical practice. MATERIALS AND METHODS General informationTwo hundred and thirty-eight patients undergoing D2 radical gastrectomy by well experienced general surgeons in our department from January 2009 to May 2014 were included; the detailed information of tumor staging can be seen in Figure 1. All patients provided informed consent, and signed agreements. All the patients were preoperatively examined, through upper abdominal 64 multi-slice computed tomography angiography (MSCTA), to determine whether there was variation in the celiac trunk and its branches, wherein the abnormal hepatic artery was classified with reference to Hiatt's [4] classification. Inclusion and exclusion criteriaInclusion criteria: (1) preoperative pathology via gastroscopic biopsy indicated gastric cancer; (2) preoperative MSCTA was taken; (3) preoperative assessment showed indications for D2 radical surgery; (4) preoperative assessment showed no evident surgical contraindication; and (5) D2 or D2+ radical su...

BackgroundThe aim of this study was to explore the prognostic factors and establish a nomogram to predict the long-term survival of gastric cancer patients.MethodsThe clinicopathological data of 421 gastric cancer patients, who were treated with radical D2 lymphadenectomy by the same surgical team between January 2009 and March 2017, were collected. The analysis of long-term survival was performed using Cox regression analysis. Based on the multivariate analysis results, a prognostic nomogram was formulated to predict the 5-year survival rate probability.ResultsIn the present study, the total overall 3-year and 5-year survival rates were 58.7 and 45.8%, respectively. The results of the univariate Cox regression analysis revealed that tumor staging, tumor location, Borrmann type, the number of lymph nodes dissected, the number of lymph node metastases, positive lymph nodes ratio, lymphocyte count, serum albumin, CEA, CA153, CA199, BMI, tumor size, nerve invasion, and vascular invasion were prognostic factors for gastric cancer (all, P < 0.05). However, merely tumor staging, tumor location, positive lymph node ratio, CA199, BMI, tumor size, nerve invasion, and vascular invasion were independent risk factors, based on the results of the multivariate Cox regression analysis (all, P < 0.05). The nomogram based on eight independent prognostic factors revealed a well-degree of differentiation with a concordance index of 0.76 (95% CI: 0.72–0.79, P < 0.001), which was better than the AJCC-7 staging system (concordance index = 0.68).ConclusionThe present study established a nomogram based on eight independent prognostic factors to predict long-term survival in gastric cancer patients. The nomogram would be beneficial for more accurately predicting the prognosis of gastric cancer, and provide important basis for making individualized treatment plans following surgery.

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.