Clinical evaluation of the aberrant left hepatic artery arising from the left gastric artery in esophagectomy
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The left gastric artery (LGA) is commonly severed when the gastric tube is made for esophageal reconstruction. Sacrifice of the LGA can cause liver ischemic necrosis in patients with an aberrant left hepatic artery (ALHA) arising from the LGA. We experienced a case of life-threatening hepatic abscess after severing the ALHA. Therefore, the purpose of this study is to evaluate clinical outcomes of severing the ALHA.
We retrospectively enrolled 176 consecutive patients who underwent esophagectomy with gastric tube reconstruction. They were classified into the ALHA (N = 16, 9.1%) and non-ALHA (N = 160, 90.9%) groups. Univariate analysis was performed to compare the clinicopathological variables. Long-term survival was analyzed using the Kaplan–Meier method in matched pair case–control analysis.
The postoperative morbidities were not statistically different between the two groups, although serum alanine aminotransferase levels on postoperative days 1 and 3 were significantly higher in the ALHA group (36 IU/L, 14–515; 32 IU/L, 13–295) than in the non-ALHA group (24 IU/L, 8–163; 19 IU/L, 6–180), respectively (p = 0.0055; p = 0.0073). Overall survival was not statistically different between the two groups (p = 0.26).
Severe hepatic abscess occurred in 6.3% of the patients with the ALHA after esophagectomy, even though the results presented here found no statistical differences in morbidity or mortality with or without the ALHA. Surgeons should probably attempt to preserve the ALHA especially in patients with altered liver function while making a gastric tube for esophageal reconstruction.
KeywordsAberrant left hepatic artery Esophagectomy Esophageal cancer Hepatic abscess
Left gastric artery
Aberrant left hepatic artery
Serum aspartate aminotransferase level
Serum alanine aminotransferase level
Serum total bilirubin level
Chronic obstructive pulmonary disease
HM: project development, data collection and analysis and manuscript writing. HS: manuscript editing. SS, KN, AN, KW, SN and KF: rounds on patients. YH: manuscript editing.
Compliance with ethical standards
Conflict of interest
We have no conflict of interest to declare.
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