The anatomical configuration of the splenic artery influences suprapancreatic lymph node dissection in laparoscopic gastrectomy: analysis using a 3D volume rendering program
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The aim of this study is to categorize splenic artery and vein configurations, and examine their influence on suprapancreatic lymph node (LN) dissection in laparoscopic gastrectomy.
Digital Imaging and Communications in Medicine images from 169 advanced cancer patients who underwent laparoscopic gastrectomy with D2 dissection were used to reconstruct perigastric vessels in 3D using a volume rendering program (VP Planning®). Splenic artery and vein configuration were classified depending on the relative position of their lowest part in regard to the pancreas. Number of resected LNs and surgical outcomes were analyzed.
The splenic artery was categorized as superficial (36.7%), middle (49.1%), and concealed (14.2%), and the splenic vein was categorized as superior (6.5%), middle (42.0%), and inferior to the pancreas (51.5%). The number of resected LNs around the proximal half of the splenic artery (#11p) and the proportion of the splenic vein located inferiorly to the pancreas were significantly higher in splenic arteries of concealed types. LN metastasis of station #7 was an independent risk factor of LN metastasis in station #11p (p = 0.010). Concealed types showed a tendency towards longer operating times, more blood loss, longer hospital stays, and a higher postoperative morbidity.
Concealed types of splenic artery are associated with an increased difficulty in the dissection of LN station #11p around the splenic artery. A 3D volume rendering program is a useful tool to rapidly and intuitively identify individual anatomical variations, to plan a tailored surgical strategy, and to predict potential challenges.
KeywordsGastric cancer Splenic artery Vascular anatomy Lymphadenectomy
This work was supported by grants (No. 800-20160455) from the Seoul National University College of Medicine. The authors are grateful to Christopher Burel and Guy Temporal, professionals in medical English proofreading, for their valuable help in revising the manuscript.
Compliance with ethical standards
Conflict of interest
Chunchao Zhu, Seong-Ho Kong, Tae-Han Kim, Shin-Hoo Park, Rene Ronson G. Ang, Michele Diana, Luc Soler, Yun-Suhk Suh, Hyuk-Joon Lee, Jacques Marescaux, Hui Cao, and Han-Kwang Yang have no conflicts of interest or financial ties to disclose.
This retrospective study was conducted ethically in accordance with the Ethical Principles for Medical Research Involving Human Subjects, as outlined in the Declaration of Helsinki after the approval of the Institutional Review Board (IRB) of the Seoul National University Hospital. Informed consent was waived by the Institutional Review Board based on their decision that the risk of this study is minimal for the patient.
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