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Surgical Endoscopy

, Volume 32, Issue 8, pp 3697–3705 | Cite as

The anatomical configuration of the splenic artery influences suprapancreatic lymph node dissection in laparoscopic gastrectomy: analysis using a 3D volume rendering program

  • Chunchao Zhu
  • Seong-Ho KongEmail author
  • Tae-Han Kim
  • Shin-Hoo Park
  • Rene Ronson G. Ang
  • Michele Diana
  • Luc Soler
  • Yun-Suhk Suh
  • Hyuk-Joon Lee
  • Jacques Marescaux
  • Hui Cao
  • Han-Kwang Yang
Dynamic Manuscript

Abstract

Background

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.

Methods

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.

Results

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.

Conclusion

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.

Keywords

Gastric cancer Splenic artery Vascular anatomy Lymphadenectomy 

Notes

Acknowledgements

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.

Ethics statement

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.

Supplementary material

Supplementary material 1 (MP4 165694 KB)

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Chunchao Zhu
    • 1
    • 2
  • Seong-Ho Kong
    • 1
    Email author
  • Tae-Han Kim
    • 1
    • 6
  • Shin-Hoo Park
    • 1
  • Rene Ronson G. Ang
    • 1
    • 3
  • Michele Diana
    • 4
  • Luc Soler
    • 4
  • Yun-Suhk Suh
    • 1
  • Hyuk-Joon Lee
    • 1
    • 5
  • Jacques Marescaux
    • 4
  • Hui Cao
    • 2
  • Han-Kwang Yang
    • 1
    • 5
  1. 1.Department of SurgerySeoul National University HospitalSeouslSouth Korea
  2. 2.Department of Gastrointestinal Surgery, Renji HospitalShanghai Jiaotong University School of MedicineShanghaiPeople’s Republic of China
  3. 3.Department of General SurgeryCebu Doctors’ University HospitalCebuPhilippines
  4. 4.IRCAD, Research Institute against Digestive CancerStrasbourgFrance
  5. 5.Cancer Research InstituteSeoul National UniversitySeoulSouth Korea
  6. 6.Department of SurgeryGyeongsang National University HospitalChangwonSouth Korea

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