The application of the abnormal hepatic artery derived from superior mesenteric artery in D2 radical gastrectomy / 中华外科杂志

ABSTRACT

<p><b>OBJECTIVES</b>To classify the courses of the abnormal hepatic arteries originated from superior mesenteric artery in patients with gastric cancer, and to define its application in the D2 radical gastrectomy in those patients.</p><p><b>METHODS</b>Eighty-six patients with gastric cancer who had received D2 radical gastrectomy by the same surgeon between January 2008 and June 2010 were included in this study. All patients received the preoperative multislice spiral computed tomoangiography (MSCTA) to classify the abnormal hepatic artery originated from the superior mesenteric artery, which was verified during the surgery. Postoperative immunohistochemistry of the lymphoid tissues around the abnormal hepatic artery was performed by recombinant human cytokeratin 20 (CK20) and carcino-embryonic antigen (CEA) to verify the micrometastasis.</p><p><b>RESULTS</b>In this group, the abnormal hepatic artery originated from the superior mesenteric artery were found with MSCTA and verified by operation in 14 patients, including 12 men and 2 women. The mean age was 62 years. Of the 14 cases with abnormal hepatic artery, 3 cases were found with abnormal common hepatic artery and 11 cases with abnormal right hepatic artery. The total mutation rate is 16.3%. In those patients, the hepatic artery ran in front of the pancreas in 1 case and behind the pancreas in 13 cases. It was difficult to dissect the abnormal hepatic artery, especially for the post-pancreas type in D2 lymphadenectomy, for fear of damaging the abnormal blood vessel and pancreas. The operation time in cases with abnormal hepatic artery was significantly longer than that in patients with normal hepatic artery [(218.8 ± 23.9) min vs. (179.6 ± 18.5) min]. Immunohistochemical analysis revealed no metastasis in the lymphoid tissues surrounding the abnormal artery.</p><p><b>CONCLUSIONS</b>Abnormal hepatic arteries originated from the superior mesenteric artery can be classified into pre-pancreas type and post-pancreas type. The dissection of the abnormal hepatic artery is not advocated in D2 radical gastrectomy for no lymph node metastasis is found around the abnormal hepatic artery in this study.</p>