Advertisement

Surgical and Radiologic Anatomy

, Volume 40, Issue 7, pp 749–756 | Cite as

Clinical evaluation of the aberrant left hepatic artery arising from the left gastric artery in esophagectomy

  • Harufumi Maki
  • Hitoshi Satodate
  • Shouichi Satou
  • Kentaro Nakajima
  • Atsuki Nagao
  • Kazuteru Watanabe
  • Satoshi Nara
  • Kaoru Furushima
  • Yasushi Harihara
Anatomic Bases of Medical, Radiological and Surgical Techniques
  • 81 Downloads

Abstract

Purpose

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.

Methods

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.

Results

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).

Conclusions

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.

Keywords

Aberrant left hepatic artery Esophagectomy Esophageal cancer Hepatic abscess 

Abbreviations

LGA

Left gastric artery

ALHA

Aberrant left hepatic artery

CT

Computed tomography

AST

Serum aspartate aminotransferase level

ALT

Serum alanine aminotransferase level

T.Bil

Serum total bilirubin level

COPD

Chronic obstructive pulmonary disease

Notes

Authors’ contribution

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.

Funding

None.

Compliance with ethical standards

Conflict of interest

We have no conflict of interest to declare.

Supplementary material

276_2018_2022_MOESM1_ESM.docx (28 kb)
Supplementary material 1 (DOCX 27 KB)

References

  1. 1.
    Backemar L, Lagergren P, Johar A, Lagergren J (2015) Impact of co-morbidity on mortality after oesophageal cancer surgery. Br J Surg 102:1097–1105CrossRefPubMedGoogle Scholar
  2. 2.
    Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Hemming AW, Finley RJ, Evans KG, Nelems B, Fradet G (1992) Esophagogastrectomy and the variant left hepatic artery. Ann Thorac Surg 54:166–168CrossRefPubMedGoogle Scholar
  4. 4.
    Hess NR, Rizk NP, Luketich JD, Sarkaria IS (2017) Preservation of replaced left hepatic artery during robotic-assisted minimally invasive esophagectomy: a case series. Int J Med Robot.  https://doi.org/10.1002/rcs.1802 PubMedCrossRefGoogle Scholar
  5. 5.
    Huang CM, Chen QY, Lin JX, Zheng CH, Li P, Xie JW et al (2013) Short-term clinical implications of the accessory left hepatic artery in patients undergoing radical gastrectomy for gastric cancer. PLoS One 8(5):e64300CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Kanda Y (2013) Investigation of the freely available easy-to-use software ‘EZR’ for medical statistics. Bone Marrow Transpl 48:452–458CrossRefGoogle Scholar
  7. 7.
    Kanehara & Co., Ltd (2008) Japanese Society of Esophageal Diseases. Japnanese Classification of Esophageal Cancer (Tenth Edition) TokyoGoogle Scholar
  8. 8.
    Kim J, Kim SM, Seo JE, Ha MH, An JY, Choi MG et al (2016) Should an aberrant left hepatic artery arising from the left gastric artery be preserved during laparoscopic gastrectomy for early gastric cancer treatment? J Gastric Cancer 16(2):72–77CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Lee SH, Kim KH, Choi CW, Kim SJ, Kim DH, Choi CI et al (2017) Atraumatic liver retraction using nelaton catheters during totally laparoscopic gastrectomy. Surg Laparosc Endosc Percutan Tech 27(6):485–490.  https://doi.org/10.1097/SLE.0000000000000489 CrossRefPubMedGoogle Scholar
  10. 10.
    Lurie AS (1987) The significance of the variant left accessory hepatic artery in surgery for proximal gastric cancer. Arch Surg 122:725–728CrossRefPubMedGoogle Scholar
  11. 11.
    Mavilia MG, Molina M, Wu GY (2016) The evolving nature of hepatic abscess: a review. J Clin Transl Hepatol 4:158–168PubMedPubMedCentralGoogle Scholar
  12. 12.
    Mays ET, Wheeler CS (1974) Demonstration of collateral arterial flow after interruption of hepatic arteries in man. N Engl J Med 290:993–996CrossRefPubMedGoogle Scholar
  13. 13.
    Miyayama S, Yamashiro M, Shibata Y, Hashimoto M, Yoshida M, Tsuji K et al (2012) Variations in feeding arteries of hepatocellular carcinoma located in the left hepatic lobe. Jpn J Radiol 30(6):471–479.  https://doi.org/10.1007/s11604-012-0075-6 CrossRefPubMedGoogle Scholar
  14. 14.
    Okano S, Sawai K, Taniguchi H, Takahashi T (1993) Aberrant left hepatic artery arising from the left gastric artery and liver function after radical gastrectomy for gastric cancer. World J Surg 17:70–73 (discussion 4)CrossRefPubMedGoogle Scholar
  15. 15.
    Oki E, Sakaguchi Y, Hiroshige S, Kusumoto T, Kakeji Y, Maehara Y (2011) Preservation of an aberrant hepatic artery arising from the left gastric artery during laparoscopic gastrectomy for gastric cancer. J Am Coll Surg 212:e25–e7CrossRefGoogle Scholar
  16. 16.
    Randjelovic DT, Filipovic RB, Bilanovic LD, Stanisavljevic SN (2007) Perigastric vascular abnormalities and the impact on esophagogastrectomy. Dis Esophagus 20:390–398CrossRefPubMedGoogle Scholar
  17. 17.
    Shinohara T, Ohyama S, Muto T, Yanaga K, Yamaguchi T (2007) The significance of the aberrant left hepatic artery arising from the left gastric artery at curative gastrectomy for gastric cancer. Eur J Surg Oncol 33:967–971CrossRefPubMedGoogle Scholar
  18. 18.
    Sohda M, Kuwano H (2017) Current status and future prospects for esophageal cancer treatment. Ann Thorac Cardiovasc Surg 23:1–11CrossRefPubMedGoogle Scholar
  19. 19.
    Valmasoni M, Pierobon ES, De Pasqual CA, Zanchettin G, Moletta L, Salvador R et al (2017) Esophageal cancer surgery for patients with concomitant liver cirrhosis: a single-center matched-cohort study. Ann Surg Oncol 24(3):763–769CrossRefPubMedGoogle Scholar
  20. 20.
    Yasuda M, Saeki H, Nakashima Y, Yukaya T, Tsutsumi S, Tajiri H et al (2015) Treatment results of two-stage operation for the patients with esophageal cancer concomitant with liver dysfunction. J Med Invest 62(3–4):149–153CrossRefPubMedGoogle Scholar
  21. 21.
    Zhang W, Yu D, Peng J, Xu J, Wei Y (2017) Gastric-tube versus whole-stomach esophagectomy for esophageal cancer: a systematic review and meta-analysis. PLoS One 12:e0173416CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer-Verlag France SAS, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of SurgeryNTT Medical Center TokyoTokyoJapan

Personalised recommendations