Early gastric cancer with an Adachi type VI (group 26) vascular anomaly diagnosed preoperatively and treated by laparoscopic surgery: a case report

Abstract

Background It is important to understand the branching pattern of the celiac artery for a safe surgery. Various branching anomalies of the celiac artery were classified by Adachi in 1928. In Adachi’s classification, type VI (group 26) is a rare anatomical anomaly (0.4%) that requires care when carrying out a surgery in gastric cancer patients with this anomaly. Herein, we reported a case treated successfully with laparoscopic distal gastrectomy with D1+ lymph node dissection for early gastric cancer. Case presentation An 84-year-old female was referred to our division for an additional surgical treatment for early gastric cancer that was resected by endoscopic submucosal dissection. A three-dimensional computed tomography angiography revealed an angioplany of the common hepatic artery branching from the left gastric artery. According to Adachi’s classification, the anomaly of this patient corresponded to type VI (group 26). Preoperative anatomical information of this rare anomaly helped us to safely perform a laparoscopic distal gastrectomy and lymph node dissection with common hepatic artery preservation. The patient had an uneventful postoperative course and was discharged on postoperative day 11. Conclusions We consider that Group 26 anomalies require the most precise anatomical understanding among Adachi classification type VIs, since it affects hepatic blood flow and can cause serious complications. In this time, we reported a successful case to perform laparoscopic distal gastrectomy with safety and accuracy by preoperative understanding of the precise vascular anatomy.

Study On The Application of Preoperative Three-Dimensional CT Angiography of Perigastric Arteries In Laparoscopic Radical Gastrectomy

“…For decades, the classi cation of perigastric arteries has been a concern by gastrointestinal surgeons. Many studies 9,10,15 reported the classi cation of gastric peripheral arteries and carried out detailed classi cation. Among them, Adachi classi cation and Hiatt classi cation are more classical.…”

“…The celiac trunk branches classi cation according to Adachi criteria 9 were Type I (118/125, 94.4%) ,Type II (3/125, 2.4%),Type IV (1/125, 0.8%),Type V (2/125, 1.6%),Type VI (1/125, 0.8%)(Table 1). The hepatic artery according to Hiatt classi cation standard 10 was Type I (102/125, 81.6%),Type II (9/125, 7.2%),Type III (6/125, 4.8%),Type IV (2/125, 1.6%),Type V (3/125, 2.4%),Type VI (0, 0%),Others: 3 cases (3/125, 1.6%).…”

“…The classi cation of the celiac trunk and its branches was according to Adachi classi cation 9 : Type I:…”

Anomalous vascular anatomy of the left gastric artery in oesophagectomy

“…Our case is consistent with one subgroup of Adachi type VI or Michels type X, which designates hepatic blood flow is being supplied solely from the replaced CHA, connecting to the GDA and the RGEA. Significant caution is required for this anomaly as reported in gastric cancer surgery because the coeliac CHA, a landmark for suprapancreatic nodal dissection, is lacking 4–7 . Furthermore, the arterial liver flow is fully halted when replaced CHA is inadvertently divided during lymph node dissection.…”

“…Significant caution is required for this anomaly as reported in gastric cancer surgery because the coeliac CHA, a landmark for suprapancreatic nodal dissection, is lacking. [4][5][6][7] Furthermore, the arterial liver flow is fully halted when replaced CHA is inadvertently divided during lymph node dissection. More importantly, the RGEA, the major feeding artery of the gastric conduit after oesophagectomy, appears to be significantly impaired by replaced CHA division.…”