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KMID : 0914820160160020072
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Journal of the Korean Gastric Cancer Association
2016 Volume.16 No. 2 p.72 ~ p.77
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Should an Aberrant Left Hepatic Artery Arising from the Left Gastric Artery Be Preserved during Laparoscopic Gastrectomy for Early Gastric Cancer Treatment?
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Kim Ji-Eun
Kim Su-Mi
Seo Jeong-Eun
Ha Man-Ho
An Ji-Yeong
Choi Min-Gew
Lee Jun-Ho
Bae Jae-Moon
Kim Sung
Jeong Woo-Kyoung
Sohn Tae-Sung
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Abstract
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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 aminotrans-ferase (AST) and alanine aminotransferase (ALT) levels on postoperative day 1 in the ALHA-ligated group (P=0.039, P=0.026, respec-tively). 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 gas-trectomy to prevent immediate postoperative hepatic dysfunction.
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KEYWORD
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Laparoscopic surgery, Gastrectomy, Aberrant left hepatic artery, Stomach neoplasms
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