Safety of Ligation of Aberrant Left Hepatic Artery Originating from Left Gastric Artery in Laparoscopic Gastrectomy for Gastric Cancer

Rene Ronson G Ang,Han-Kwang Yang,Hyuk-Joon Lee,Tae Han Kim,Jae Seok Bae,Se Hyung Kim,Felix Berlth,Seong-Ho Kong,Yun-Suhk Suh,Shin-Hoo Park,Chun-Chao Zhu

doi:10.1038/s41598-020-62587-7

Abstract

There are still lot of controversies whether aberrant left hepatic artery (ALHA) originating from left gastric artery should be ligated or preserved during gastric cancer (GC) surgery. We aimed to investigate this issue. We reviewed ALHA cases who had laparoscopic gastrectomy for gastric cancer at Seoul National University Hospital (SNUH) from 2012 to 2016. Type of ALHA variants using Michel’s classification of hepatic arterial anatomy and diameter of each vessel were evaluated by 2 radiologists. Postoperative hepatic function and surgical outcome were collected until 6 months after surgery. Results showed that if the diameter of ALHA was larger than 1.5 mm, a transient elevation of SGOT and SGPT on postoperative day 2 was observed in the ligated cases. No differences were observed in operation time, amount of blood loss, overall complication rate, hospital stay, and number of lymph nodes retrieved between the ligated and preserved replaced left hepatic artery (RLHA) and accessory left hepatic artery (acLHA) group. In this study, we conclude that ligation of ALHA seems to be safe as none of the patients suffered adverse outcome. A transient rise in postoperative SGOT and SGPT levels were seen after ligating ALHA >1.5 mm in diameter regardless of subtype.

Highlights

Oncologic gastric surgery requires complete station 7 lymph node dissection5
There were 21 patients with pre-existing hepatic disease which includes drug induced liver injury (DILI), hepatitis infection and liver cirrhosis, 14 of these patients are in the replaced left hepatic artery (RLHA)-preserved group, 1 in accessory left hepatic artery (acLHA)-preserved, 3 in RLHA-ligated and 3 in acLHA-ligated group
Laparoscopic gastrectomy with oncologic lymph node dissection has been recommended for treatment of early gastric cancer in Japan and Korea[16,17,18]

Summary

Introduction

Oncologic gastric surgery requires complete station 7 lymph node dissection. In order to achieve this, left gastric artery should be ligated at the base to ensure en bloc lymph node dissection which means that when ALHA is present it should be ligated. There were no difference in oncologic outcome between patients whose aberrant left hepatic artery were preserved or ligated during gastric cancer surgery as reported by Shinohara et al., many surgeons believed that preserving ALHA during surgery increases the operation time and blood loss especially during laparoscopic procedures. The objective www.nature.com/scientificreports of this study is to determine if ligation of ALHA during laparoscopic gastrectomy for gastric cancer is safe with regards to patient’s postoperative short-term outcome and oncologic safety

Objectives

Methods

Results

Conclusion