Successful laparoscopic distal gastrectomy with D2 lymph node dissection preserving the common hepatic artery branched from the left gastric artery for advanced gastric cancer with an Adachi type VI (group 26) vascular anomaly

Abstract

We report a case of successful laparoscopic distal gastrectomy with D2 lymph node dissection preserving the common hepatic artery branched from the left gastric artery for advanced gastric cancer with an Adachi type VI (group 26) vascular anomaly. A 76-year-old female patient was admitted with a diagnosis of advanced gastric cancer at the anterior wall to the lesser curvature of the antrum (cT3N0M0 cStage IIA). Dynamic computed tomography showed the ectopia of the common hepatic artery branched from the left gastric artery. We made a diagnosis of an Adachi type VI (group 26) vascular anomaly and performed the abovementioned operation. In this anomaly pattern, scrupulous attention is required to remove the suprapancreatic lymph nodes because the portal vein is located immediately dorsal to those lymph nodes and is at increased risk for the injury in this situation. The common hepatic artery is branched from the left gastric artery, and the hepatic perfusion from the superior mesenteric artery is not present in group 26. Planning to preserve the artery will improve safety when it is possible oncologically. There were no postoperative complications, and the patient was discharged 9 days after the operation. To our knowledge, the present case is the first reported case of a laparoscopic distal gastrectomy with D2 lymph node dissection with an Adachi type VI (group 26) vascular anomaly. Preoperative diagnostic imaging is very important to prevent surgical complications because the reliable identification of vascular anomaly during an operation is very difficult.

Branching form of celiac artery to be aware of in laparoscopic surgery: A case report using MDCT angiography

“…The IPDA developed and the GDA was thinner than normal, predicting the blood supply vessel to the anterior superior pancreaticoduodenal artery by the IPDA. We noted that a case report on the CHA branching from the LGA was similar to our case [19] . However, we could not find any previous reports on complex branches of the CA and SMA, as in this case; hence, to the best of our knowledge, this is the first reported case.…”

Robotic distal gastrectomy with D2 lymphadenectomy for advanced gastric cancer with celiac‐arterial anomaly (Adachi type VI, group 26): Case report

“…1,2 A search of English language articles published between 2010 and 2022 on PubMed using the keywords, "arterial anomaly" and either "laparoscopic gastrectomy" or "robotic gastrectomy," found only three cases of gastric cancer with a similar, arterial anomaly treated with a laparoscopic distal gastrectomy (Table 1). [3][4][5] However, a case of RDG similar to the present one was first reported in Japanese in 2012 (SHIKOKU ACTA MEDICA, 2012;68(1-2): 53-8).…”

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

“…Therefore, it’s possible that the left gastric artery could be divided at the root without knowledge. In Japan, 3 gastric cancer cases with an Adachi type VI and group 26 anomaly have been reported (Table 1 ) [ 5 – 7 ]. In 1 of the 4 cases, including our case, the vascular anomaly was not identified prior to surgery, and the left gastric artery was divided at the root [ 6 ].…”