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

ABSTRACT

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.