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

Abstract

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...

Absence of the celiac trunk and trifurcation of the common hepatic artery: a case report

“…Celiac artery variations are said to increase both the difficulty and the risk of radical gastrectomy. 23 …”

Celiac Trunk and Hepatic Arteries: Anatomical Variations of Liver Arterial Supply as Detected with Multidetector Computed Tomography in 1,520 Patients and its Clinical Importance

“…Arterial variants are also important in gastric cancer surgery since radical gastrectomy with extensive lymphadenectomy (requiring resection of lymph nodes around the LGA, CTr and hepatic arteries) becomes standard practice. Huang et al (2015) compared groups with and without CTr variations and found that in operations on the variant group, the duration was significantly prolonged and intraoperative bleeding and postoperative drainage were significantly increased. Moreover, the LGA has to be ligated and cut off, leading to liver dysfunction if there is an aberrant LHA deriving from it.…”

Variations of the celiac trunk investigated by multidetector computed tomography: Systematic review and meta‐analysis with clinical correlations

“…A funnel plot with this study removed is given in Data S6. Data regarding complete celiac trunks with visceral collaterals were described in eight studies (Araujo Neto et al, 2015;Awad et al, 2017;Farghadani et al, 2016;Huang et al, 2015;Khan et al, 2017;Kornafel et al, 2010;Marco-Clement et al, 2016;Ramanand et al, 2018). From a total of 2,493 complete celiac trunks there were T A B L E 1 Overview of the variations Only one study investigated the parietal collaterals of the celiac trunk.…”