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The Short-Term Outcomes of Gastric Cancer Patients Based on a Proposal for a Novel Classification of Perigastric Arteries

  • Shuai Shen
  • Shougen Cao
  • Haitao Jiang
  • Shanglong Liu
  • Xiaodong Liu
  • Zequn Li
  • Dan Liu
  • Yanbing ZhouEmail author
Original Article
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Abstract

Purpose

To establish a novel classification of perigastric arteries by computerized tomography angiography (CTA) and discuss its influence in patients’ short-term clinical outcomes.

Methods

The clinical data were analyzed retrospectively from 680 gastric cancer patients. The types of the perigastric artery were classified according to CTA image and we compared the short-term clinical outcomes.

Results

The perigastric arteries can be divided into seven categories. Type I, trifurcation of the celiac trunk (CT) (294/343, 85.7%); type II, hepatosplenic trunk, left gastric artery (LGA) arising from the abdominal aorta (8/343, 2.3%); type III, hepatogastric trunk, splenic artery arising from the superior mesenteric artery (SMA) (2/343, 0.6%); type IV, celiacomesenteric trunk (5/343, 1.5%); type V, common hepatic artery (CHA) arising from the SMA, gastrosplenic trunk (11/343, 3.2%); type VI, aberrant (accessory or replaced) left hepatic artery arising from LGA (21/343, 6.1%); and type VII, CHA arising from LGA (2/343, 0.6%). The number of retrieved LNs in the CTA group was significantly higher than that in the non-CTA group. However, the operation time, estimated blood loss, intraoperative vascular injury, and medical cost of the CTA group were significantly less than those in the non-CTA group. Of note, in patients with BMI ≥ 25.0, higher LNs retrieval and less vascular injury were still present in the CTA group, which was of vital importance in clinical practice. Furthermore, the CTA group displayed shorter hospital stay (LOS).

Conclusion

We established a new perigastric artery classification. Application of the classification can improve the short-term clinical outcomes of patients.

Keywords

Gastrectomy CTA Vascular variation Clinical outcome 

Notes

Authors’ Contributions

Shuai Shen and Yanbing Zhou were involved in the conception, design, data acquisition, analysis, and interpretation and production of figures and tables. Shuai Shen wrote the first draft and revised it critically in light of comments from other authors. Shougen Cao, Haitao Jiang, and Shanglong Liu were involved in the conception, interpretation, manuscript revision, and discussion. Xiaodong Liu, Zequn Li, and Dan Liu were involved in the data acquisition and literature review. All authors approved the final version submitted.

Funding Information

This study was supported by the National Natural Science Foundation of China (No. 81572314).

Compliance with Ethical Standards

Ethical Approval

All patients signed an informed consent document before the examination and surgery. The Ethics Committee of the Affiliated Hospital of Qingdao University approved this retrospective study.

Conflict of Interest

The authors declare that they have no conflict of interest.

References

  1. 1.
    Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A: Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries.CA Cancer J Clin 2018, 68:394-424.Google Scholar
  2. 2.
    Kim HH, Han SU, Kim MC, Hyung WJ, Kim W, Lee HJ, Ryu SW, Cho GS, Song KY, Ryu SY: Long-term results of laparoscopic gastrectomy for gastric cancer: a large-scale case-control and case-matched Korean multicenter study.J Clin Oncol 2014, 32:627-633.CrossRefGoogle Scholar
  3. 3.
    Sano T, Martin IG: Lymphadenectomy and pancreatico-splenectomy in gastric cancer surgery.Lancet 1996, 348:195-196.CrossRefGoogle Scholar
  4. 4.
    Surgery B, Robotic and Laparoscopic Surgery Committee of Chin: Guideline for laparoscopic gastrectomy for gastric cancer(2016 edition)Chinese Journal of Digestive Surgery 2016, 15:851-857.Google Scholar
  5. 5.
    Japanese Gastric Cancer A: Japanese gastric cancer treatment guidelines 2010 (ver. 3).Gastric Cancer 2011, 14:113-123.Google Scholar
  6. 6.
    Dindo D, Demartines N, Clavien PA: Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey.Ann Surg 2004, 240:205-213.CrossRefGoogle Scholar
  7. 7.
    Sasako M, McCulloch P, Kinoshita T, Maruyama K: New method to evaluate the therapeutic value of lymph node dissection for gastric cancer.Br J Surg 1995, 82:346-351.CrossRefGoogle Scholar
  8. 8.
    Michels NA: Newer anatomy of the liver and its variant blood supply and collateral circulation.Am J Surg 1966, 112:337-347.CrossRefGoogle Scholar
  9. 9.
    Hiatt JR, Gabbay J, Busuttil RW: Surgical anatomy of the hepatic arteries in 1000 cases.Ann Surg 1994, 220:50-52.CrossRefGoogle Scholar
  10. 10.
    Lipshutz B: A Composite Study of the Coeliac Axis Artery.Ann Surg 1917, 65:159-169.CrossRefGoogle Scholar
  11. 11.
    Lopez-Andujar R, Moya A, Montalva E, Berenguer M, De Juan M, San Juan F, Pareja E, Vila JJ, Orbis F, Prieto M, Mir J: Lessons learned from anatomic variants of the hepatic artery in 1,081 transplanted livers.Liver Transpl 2007, 13:1401-1404.CrossRefGoogle Scholar
  12. 12.
    Song SY, Chung JW, Yin YH, Jae HJ, Kim HC, Jeon UB, Cho BH, So YH, Park JH: Celiac axis and common hepatic artery variations in 5002 patients: systematic analysis with spiral CT and DSA.Radiology 2010, 255:278-288.CrossRefGoogle Scholar
  13. 13.
    Matsuki M, Kani H, Tatsugami F, Yoshikawa S, Narabayashi I, Lee SW, Shinohara H, Nomura E, Tanigawa N: Preoperative assessment of vascular anatomy around the stomach by 3D imaging using MDCT before laparoscopy-assisted gastrectomy.AJR Am J Roentgenol 2004, 183:145-151.CrossRefGoogle Scholar
  14. 14.
    Jones RM, Hardy KJ: The hepatic artery: a reminder of surgical anatomy.J R Coll Surg Edinb 2001, 46:168-170.PubMedGoogle Scholar
  15. 15.
    Liu ST: Rare case of left colic flexure is supplied by a branch from splenic artery--a case report.Kaohsiung J Med Sci 2002, 18:205-207.PubMedGoogle Scholar
  16. 16.
    Kozhevnikova TI: [Age and individual characteristics in the structure of the celiac trunk in man].Arkh Anat Gistol Embriol 1977, 72:19-25.PubMedGoogle Scholar
  17. 17.
    Yamashita K, Sakuramoto S, Mieno H, Shibata T, Nemoto M, Katada N, Kikuchi S, Watanabe M: Preoperative dual-phase 3D CT angiography assessment of the right hepatic artery before gastrectomy.Surg Today 2014, 44:1912-1919.CrossRefGoogle Scholar
  18. 18.
    Silveira LA, Silveira FB, Fazan VP: Arterial diameter of the celiac trunk and its branches. Anatomical study.Acta Cir Bras 2009, 24:43-47.CrossRefGoogle Scholar
  19. 19.
    Hemming AW, Finley RJ, Evans KG, Nelems B, Fradet G: Esophagogastrectomy and the variant left hepatic artery.Ann Thorac Surg 1992, 54:166-168.CrossRefGoogle Scholar
  20. 20.
    Lurie AS: The significance of the variant left accessory hepatic artery in surgery for proximal gastric cancer.Arch Surg 1987, 122:725-728.CrossRefGoogle Scholar
  21. 21.
    Oki E, Sakaguchi Y, Hiroshige S, Kusumoto T, Kakeji Y, Maehara Y: Preservation of an aberrant hepatic artery arising from the left gastric artery during laparoscopic gastrectomy for gastric cancer.J Am Coll Surg 2011, 212:e25-27.CrossRefGoogle Scholar
  22. 22.
    Yamamoto M, Zaima M, Yamamoto H, Harada H, Kawamura J, Yamada M, Yazawa T, Kawasoe J: Liver necrosis shortly after pancreaticoduodenectomy with resection of the replaced left hepatic artery.World J Surg Oncol 2017, 15:77.CrossRefGoogle Scholar
  23. 23.
    Huang Y, Mu GC, Qin XG, Chen ZB, Lin JL, Zeng YJ: Study of celiac artery variations and related surgical techniques in gastric cancer.World J Gastroenterol 2015, 21:6944-6951.CrossRefGoogle Scholar
  24. 24.
    Sauer IM, Queisner M, Tang P, Moosburner S, Hoepfner O, Horner R, Lohmann R, Pratschke J: Mixed Reality in Visceral Surgery: Development of a Suitable Workflow and Evaluation of Intraoperative Use-cases.Ann Surg 2017, 266:706-712.CrossRefGoogle Scholar

Copyright information

© The Society for Surgery of the Alimentary Tract 2019

Authors and Affiliations

  • Shuai Shen
    • 1
  • Shougen Cao
    • 1
  • Haitao Jiang
    • 1
  • Shanglong Liu
    • 1
  • Xiaodong Liu
    • 1
  • Zequn Li
    • 1
  • Dan Liu
    • 1
  • Yanbing Zhou
    • 1
    Email author
  1. 1.Department of Gastrointestinal SurgeryAffiliated Hospital of Qingdao UniversityQingdao CityChina

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