Preoperative Assessment of Vascular Anatomy Around the Stomach by 3D Imaging Using MDCT Before Laparoscopy-Assisted Gastrectomy

Matsuki, Mitsuru; Kani, Hiroyuki; Tatsugami, Fuminari; Yoshikawa, Shushi; Narabayashi, Isamu; Lee, Sang‐Woong; Shinohara, Hisashi; Nomura, Eiji; Tanigawa, Nobuhiko

doi:10.2214/ajr.183.1.1830145

Cited by 72 publications

(39 citation statements)

References 13 publications

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“…This may be attributed to the fact that the previous studies mainly focused on intraoperative anatomic findings during hepatic implantation, and were subject to ignore small vascular anomalies. The majority were replaced/accessory left hepatic artery, with an incidence of 16.8%, which is similar to that reported in literature [12][13][14][15] . Replaced/ accessory left hepatic artery has important implications in D2 radical gastrectomy.…”

Section: Discussionsupporting

confidence: 89%

Study of celiac artery variations and related surgical techniques in gastric cancer

Huang¹,

Mu²,

Qin³

et al. 2015

WJG

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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...

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Section: Discussionsupporting

confidence: 89%

Study of celiac artery variations and related surgical techniques in gastric cancer

Huang¹,

Mu²,

Qin³

et al. 2015

WJG

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“…Three-dimensional computed tomographic angiography (3DCTA) is a reliable method for determining the location and anatomy of the vessels around the stomach [3][4][5][6][7][8]. However, this method requires an additional CT scan over and above the routine CT, so extra cost is incurred.…”

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confidence: 99%

Multidetector computed tomography for preoperative identification of left gastric vein location in patients with gastric cancer

et al. 2010

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Background. The area near the left gastric vein (LGV) is a challenging site at which to perform dissection of the lymph nodes during gastrectomy. Therefore, knowledge of the precise location of the LGV is important. The objective of this study was to examine the usefulness of multidetector computed tomography (MDCT) for the identifi cation of the LGV. Methods. Eighty-one patients with gastric cancer underwent MDCT, which was performed with contrast media in 76 patients and without contrast media in 5 patients. A 5-mm thin slice of the frontal image was reconstructed. These images were examined preoperatively to detect the location of the LGV. Upon gastrectomy, the LGV was identifi ed and its location compared to that determined by MDCT. Results. The LGV was identifi ed by MDCT in 76 of the 81 patients (93.8%). The LGV was subsequently located during the operation in all 81 patients. The LGV was located dorsal to the common hepatic artery in 40 patients (49.4%), ventral to the common hepatic artery in 18 patients (22.2%), ventral to the splenic artery in 17 patients (21.0%), dorsal to the splenic artery in 2 patients (2.5%) and in other positions in 4 patients (4.9%). In all patients, the location of the LGV detected using MDCT was consistent with that identifi ed during gastrectomy. In the 4 patients with relatively unusual locations of the LGV, these 4 LGV variants were identifi ed preoperatively by MDCT. Conclusion. MDCT was useful for identifying the location of the LGV prior to gastrectomy.

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“…6 and no. 11p lymph nodes, respectively [9][10][11]. In the present patient, a vascular anomaly was diagnosed, in which the right hepatic artery branched directly from the celiac axis and ran posterior to the splenic vein; this vascular branching pattern made surgical resection possible.…”

Section: Discussionmentioning

confidence: 63%

Advanced gastric cancer with a duplicated hepatic artery: preoperative diagnostic value of multidetector-row computed tomography for surgical resection

et al. 2007

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In patients with T4 gastric cancer, curative surgery can be achieved with concomitant resection of the invaded organs. However, curative resection is not necessarily possible in all cases. In patients with advanced gastric cancer with infi ltration of the pancreatic head and common hepatic artery (CHA), curative surgery is usually impossible, because pancreaticoduodenectomy (PD) with CHA resection leads to an abrupt reduction in the arterial blood supply to the liver and results in severe liver damage. We experienced a case of advanced gastric cancer that infi ltrated these organs, i.e., the pancreatic head and CHA. We were able to perform curative surgery in this patient because preoperative multidetector-row computed tomography (MDCT) revealed the presence of a duplicated hepatic artery. Here, we present a very rare case of advanced gastric cancer in a patient with a duplicated hepatic artery, and we note the value of MDCT for preoperative diagnosis. Case reportA 63-year-old Japanese woman presented to her family physician with appetite loss and general fatigue in June 2003. Gastrointestinal fi berscopy and upper gastrointestinal (GI) series revealed type 2 advanced gastric cancer in the antrum, with pyloric stenosis and duodenal invasion (Fig. 1). The patient was referred to the Cancer Institute Hospital for further examination. Laboratory examination revealed severe anemia (hemoglobin, 8.0 g/ dl) and poor nutritional condition (albumin, 3.3 g/dl). Abdominal MDCT revealed massive gastric cancer directly invading the left hepatic lobe and pancreatic head as well as vascular anomaly. Metastasized lymph nodes also invaded the CHA directly (Fig. 2). Although paraaortic lymph nodes were identifi ed, CT did not reveal any distant metastasis. In general, PD with CHA resection is considered to be impossible, because it Abstract A 63-year-old woman with appetite loss and general fatigue underwent gastrointestinal fi berscopy, which revealed type 2 advanced gastric cancer. Multidetector-row computed tomography revealed a massive gastric cancer invading the left hepatic lobe, pancreatic head, and common hepatic artery, as well as revealing a duplicated hepatic artery in which the right hepatic artery branched directly from the celiac axis, and ran behind the splenic vein. On the other hand, the common hepatic artery ran anterior to the splenic vein. We were able to perform pancreaticoduodenectomy with common hepatic artery resection and left lobectomy as curative surgery because her duplicated hepatic artery enabled us to ligate the common hepatic artery. Her postoperative clinical course was uneventful, and she is in good health 3 years after the surgery, without recurrence. We consider that multidetector-row computed tomography is very useful for the diagnosis of vascular anomaly, preoperative staging and decision making on the appropriate surgical strategy.

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Preoperative Assessment of Vascular Anatomy Around the Stomach by 3D Imaging Using MDCT Before Laparoscopy-Assisted Gastrectomy

Abstract: Three-dimensional CTA using MDCT clearly revealed individual vascular anatomies around the stomach and could play an important role in safely facilitating the laparoscopy-assisted gastrectomy procedure.

Cited by 72 publications

References 13 publications

Study of celiac artery variations and related surgical techniques in gastric cancer

Study of celiac artery variations and related surgical techniques in gastric cancer

Multidetector computed tomography for preoperative identification of left gastric vein location in patients with gastric cancer

Advanced gastric cancer with a duplicated hepatic artery: preoperative diagnostic value of multidetector-row computed tomography for surgical resection

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