Application Value of a 6-Type Classification System for Common Hepatic Artery Absence During Laparoscopic Radical Resections for Gastric Cancer

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.

MicroRNA-421 promotes the proliferation and metastasis of gastric cancer cells by targeting claudin-11

“…Gastric cancer is among the most prevalent types of malignant tumor, and has the fourth and second highest rates of incidence and mortality, respectively, among malignant tumors (1,2). Until 2015, the incidence of gastric cancer has increased on a yearly basis and two thirds of all new cases were reported in developing countries, among which China accounted for 42% (3).…”

Imaging diagnosis of aberrant proper hepatic and gastroduodenal arteries prior to pancreaticoduodenectomy: A case report

“…Huang et al. suggested 6 types of variations in the absence of the CHA; however, the type in which the PHA originates from the SMA, as seen in this case, remains unclassified [6] . Michels divided the anatomic variations in the arterial blood supply to the liver into 10 types and reported that the frequency of the entire hepatic trunk being derived from the SMA (type IX) was 2.5%.…”

“…The presence of HA variations was first reported by Haller in 1756 [10] , and several classifications for HA variations have been proposed since [4] , [5] , [6] . The embryologic context of HA is important for understanding how these variants occur.…”

“…The CHA divides into the gastroduodenal artery (GDA) and proper hepatic artery (PHA), which are the main sources of blood supply to the liver and gallbladder [3] . There are some reports on variations in the anatomy of the HA in the anatomic, radiographic, and surgical literature [4] , [5] , [6] .…”

Branching pattern variations of the celiac trunk and superior mesenteric artery in a 72-year-old white female cadaver

“…They do not originate from a typical position and have replaced a 'usual' artery branch at that location to be the primary blood supply to the corresponding organ or organ section (i.e. the left and right lobes of the liver) [19,22,69]. Knowledge of replaced arteries as variations can be lifesaving for patients with bile duct cancer.…”