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Three-dimensional computed tomography analysis of the vascular anatomy of the splenic hilum for gastric cancer surgery

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Abstract

Purpose

Splenic infarction may occur if the splenic branches are injured or ligated accidentally during gastrectomy. We used three-dimensional computed tomography (3D-CT) imaging to distinguish the vascular anatomy of the splenic hilum in individual patients, focusing on the splenic polar branches and the gastric branches.

Methods

The subjects of this study were 104 patients who underwent computed tomography (CT) with intravenous contrast before gastrectomy. SYNAPSE 3D® (Fujifilm Medical, Tokyo, Japan) was used to generate the 3D-CT images. The total spleen volume and the area supplied by the superior polar artery (SPA) in each patient were estimated using the “liver analysis” function.

Results

The SPA without the gastric branch (supplying only the spleen), the SPA with the gastric branch (supplying both the stomach and the spleen), and the posterior gastric artery (supplying only the stomach) were present in 14, 45, and 18% of the patients, respectively. The SPA supplied 12% of the total spleen volume on average; however, it supplied over 30% in two patients.

Conclusion

We identified the vascular anatomy around the splenic hilum in over 100 patients. Based on our findings, we recommend preservation of the SPA when it is supplying a large area of the spleen. Preoperative 3D-CT analysis provides useful information to optimize safe gastrectomy.

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References

  1. Sano T, Sasako M, Mizusawa J, Yamamoto S, Katai H, Yoshikawa T, et al. Randomized controlled trial to evaluate splenectomy in total gastrectomy for proximal gastric carcinoma. Ann Surg. 2017;265:277–83.

    Article  PubMed  Google Scholar 

  2. Jaroch MT, Broughan TA, Hermann RE. The natural history of splenic infarction. Surgery. 1986;100:743–50.

    PubMed  CAS  Google Scholar 

  3. Nores M, Phillips EH, Morgenstern L, Hiatt JR. The clinical spectrum of splenic infarction. Am Surg. 1998;64:182–8.

    PubMed  CAS  Google Scholar 

  4. Watanabe M, Miyata H, Gotoh M, Baba H, Kimura W, Tomita N, et al. Total gastrectomy risk model: data from 20,011 Japanese patients in a nationwide internet-based database. Ann Surg. 2014;260:1034–9.

    Article  PubMed  Google Scholar 

  5. Kunisaki C, Miyata H, Konno H, Saze Z, Hirahara N, Kikuchi H, et al. Modeling preoperative risk factors for potentially lethal morbidities using a nationwide Japanese web-based database of patients undergoing distal gastrectomy for gastric cancer. Gastric Cancer. 2017;20:496–507.

    Article  PubMed  CAS  Google Scholar 

  6. Akin K, Kosehan D, Cengiz AY, Dener NC, Koktener A, Inan A, et al. Splenic infarction following conventional open gastrectomy in patients with gastric malignancy: a CT-based study. Abdom Imaging. 2012;37:609–15.

    Article  PubMed  Google Scholar 

  7. Jung YJ, Seo HS, Lee HH, Kim JH, Song KY, Choi MH, et al. Splenic infarction as a delayed febrile complication following radical gastrectomy for gastric cancer patients: computed tomography-based analysis. World J Surg. 2017. https://doi.org/10.1007/s00268-017-4401-0. [Epub ahead of print].

    Article  PubMed  Google Scholar 

  8. Lee CM, Leung TK, Wang HJ, Lee WH, Shen LK, Liu JD, et al. Evaluation of the effect of partial splenic embolization on platelet values for liver cirrhosis patients with thrombocytopenia. World J Gastroenterol. 2007;13619–22.

  9. Hayashi H, Beppu T, Okabe K, Masuda T, Okabe H, Baba H. Risk factors for complications after partial splenic embolization for liver cirrhosis. Br J Surg. 2008;95:744–50.

    Article  PubMed  CAS  Google Scholar 

  10. Cai M, Huang W, Lin C, Li Z, Qian J, Huang M, et al. Partial splenic embolization for thrombocytopenia in liver cirrhosis: predictive factors for platelet increment and risk factors for major complications. Eur Radiol. 2016;26:370–80.

    Article  PubMed  Google Scholar 

  11. Liu DL, Xia S, Xu W, Ye Q, Gao Y, Qian J. Anatomy of vasculature of 850 spleen specimens and its application in partial splenectomy. Surgery. 1996;119:27–33.

    Article  PubMed  CAS  Google Scholar 

  12. Sow ML, Dia A, Ouedraogo T. Anatomic basis for conservative surgery of the spleen. Surg Radiol Anat. 1991;13:81–7.

    Article  PubMed  CAS  Google Scholar 

  13. Redmond HP, Redmond JM, Rooney BP, Duignan JP, Bouchier-Hayes DJ. Surgical anatomy of the human spleen. Br J Surg. 1989;76:198–201.

    Article  PubMed  CAS  Google Scholar 

  14. Zeon SK, Kim SG, Huyn JA, Kim YS. Angiographic branching patterns of the splenic artery. Int J Angiol. 1998;7:57–61.

    Article  Google Scholar 

  15. Japanese Gastric Cancer Association. Japanese classification of gastric carcinoma: 3rd English edition. Gastric Cancer. 2011;14:101–12.

    Article  Google Scholar 

  16. Suzuki K, Prates JC, DiDio LJ. Incidence and surgical importance of the posterior gastric artery. Ann Surg. 1978;187:134–6.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  17. Okabayashi T, Kobayashi M, Morishita S, Sugimoto T, Akimori T, Namikawa T, et al. Confirmation of the posterior gastric artery using multi-detector row computed tomography. Gastric Cancer. 2005;8:209 – 13.

    Article  PubMed  Google Scholar 

  18. Yu W, Whang I. Surgical implications of the posterior gastric artery. Am J Surg. 1990;159:420–22.

    Article  PubMed  CAS  Google Scholar 

  19. Trubel W, Rokitansky A, Turkof E, Firbas W. Correlations between posterior gastric artery and superior polar artery in human anatomy. Anat Anz. 1988;167:219–23.

    PubMed  CAS  Google Scholar 

  20. Kinoshita T, Shibasaki H, Enomoto N, Sahara Y, Sunagawa H, Nishida T. Laparoscopic splenic hilar lymph node dissection for proximal gastric cancer using integrated three-dimensional anatomic simulation software. Surg Endosc. 2016;30:2613–9.

    Article  PubMed  Google Scholar 

  21. Zheng CH, Xu M, Huang CM, Li P, Xie JW, Wang JB, et al. Anatomy and influence of the splenic artery in laparoscopic spleen-preserving splenic lymphadenectomy. World J Gastroenterol. 2015;21:8389–97.

    Article  PubMed  PubMed Central  Google Scholar 

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Authors and Affiliations

  1. Division of Gastroenterological Surgery, Saitama Cancer Center, 780 Komuro, Ina, Kita-adachi gun, Saitama, Saitama Prefecture, 362-0806, Japan

    Yoshiya Ishikawa, Kazuhisa Ehara, Tatsuya Yamada, Natsumi Matsuzawa, Shu Arai, Yoshiyuki Kawashima & Hirohiko Sakamoto

  2. Department of Hepatobiliary and Pancreatic Surgery, Graduate School of Medicine, Tokyo Medical and Dental University, Tokyo, Japan

    Yoshiya Ishikawa, Daisuke Ban, Atsushi Kudo & Minoru Tanabe

Authors
  1. Yoshiya Ishikawa
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  2. Kazuhisa Ehara
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  3. Tatsuya Yamada
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  4. Natsumi Matsuzawa
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  5. Shu Arai
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  6. Daisuke Ban
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  7. Atsushi Kudo
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  8. Minoru Tanabe
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  9. Yoshiyuki Kawashima
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  10. Hirohiko Sakamoto
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Corresponding author

Correspondence to Yoshiya Ishikawa.

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Conflict of interest

We declare no conflicts of interest.

Ethical approval

All the study procedures were approved by the Ethical Committee of Saitama Cancer Center (approval number 767) and were therefore performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

Informed consent

Informed consent was obtained from all participants included in the study.

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Ishikawa, Y., Ehara, K., Yamada, T. et al. Three-dimensional computed tomography analysis of the vascular anatomy of the splenic hilum for gastric cancer surgery. Surg Today 48, 841–847 (2018). https://doi.org/10.1007/s00595-018-1679-y

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  • DOI: https://doi.org/10.1007/s00595-018-1679-y

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