Should an Aberrant Left Hepatic Artery Arising from the Left Gastric Artery Be Preserved during Laparoscopic Gastrectomy for Early Gastric Cancer Treatment?

PURPOSE: During laparoscopic gastrectomy, an aberrant left hepatic artery (ALHA) arising from the left gastric artery (LGA) is occasionally encountered. The aim of this study was to define when an ALHA should be preserved during laparoscopic gastrectomy. MATERIALS AND METHODS: From August 2009 to December 2014, 1,340 patients with early gastric cancer underwent laparoscopic distal gastrectomy. One hundred fifty patients presented with an ALHA; of the ALHA was ligated in 116 patients and preserved in 34 patients. Patient characteristics, postoperative outcomes and perioperative liver function tests were reviewed retrospectively. Correlations between the diameter of the LGA measured on preoperative abdominal computed tomography and postoperative liver enzyme levels were analyzed. RESULTS: Pearson's correlation analysis showed a positive correlation between the diameter of the LGA and serum aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels on postoperative day 1 in the ALHA-ligated group (P=0.039, P=0.026, respectively). Linear regression analysis estimated the diameter of the LGA to be 5.1 mm and 4.9 mm when AST and ALT levels were twice the normal limit on postoperative day 1. CONCLUSIONS: We suggest preserving the ALHA arising from a large LGA, having diameter greater than 5 mm, during laparoscopic gastrectomy to prevent immediate postoperative hepatic dysfunction.

Implication of the Accessory Left Hepatic Artery in Curative Surgery for Gastric Cancer

We designed this study to identify the anatomic variations of the accessory left hepatic artery and to identify the influence on the hepatic function when this vessel is sacrificed during a systematic lymphadenectomy for gastric cancer. The surgical records of 100 patients who underwent curative surgery for gastric cancer, including ligation of the left gastric artery at its origin, were reviewed. The liver function was assessed by measuring the serum glutamic oxaloacetic transaminase, the glutamic pyruvic transaminase, and the alkaline phosphatase activities preoperatively and on the seventh postoperative day. The frequency of metastasis in the lymph nodes around the left gastric artery was reviewed. In 44 of the 100 cases, an accessory left hepatic artery was encountered. The accessory left hepatic artery joined with the left hepatic artery before reaching the liver in 21 of 44 cases and ran into the left lobe of the liver without confluence in 23. The diameter of the accessory left hepatic artery was greater than that of the left hepatic artery in only 17% of the cases. Metastasis in the lymph nodes around the left gastric artery was identified in 11 cases. The observed hepatic dysfunctions 7 days after operation were mild and transient, even after sacrifice of the accessory left hepatic artery. There were no postoperative complications related to the decreased liver function in these patients. These data suggest that ligation of the left gastric artery at its origin, irrespective of the presence of an accessory left hepatic artery, is necessary to improve the oncological quality of surgery without significant complication during curative surgery for gastric cancer.