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Three‐dimensional CT for preoperative detection of the left gastric artery and left gastric vein in laparoscopy‐assisted distal gastrectomy
Author(s) -
Yuasa Yasuhiro,
Okitsu Hiroshi,
Goto Masakazu,
Kuramoto Shunsuke,
Tomibayashi Atsushi,
Matsumoto Daisuke,
Edagawa Hiroshi,
Mori Osamu,
Tani Ryotaro,
Akagawa Takuya,
Kinoshita Mitsuhiro,
Akagawa Yoko,
Tani Hayato,
Ohnishi Norio,
Shirono Ryozo
Publication year - 2016
Publication title -
asian journal of endoscopic surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.372
H-Index - 18
eISSN - 1758-5910
pISSN - 1758-5902
DOI - 10.1111/ases.12280
Subject(s) - medicine , left gastric artery , dissection (medical) , vein , radiology , laparoscopy , gastrectomy , portal vein , lymph node , artery , surgery , cancer
We evaluated 3‐D CT imaging for preoperative classification of the left gastric artery and vein in patients with early gastric cancer and estimated its clinical benefit. Methods Between April 2009 and March 2014, 279 patients underwent preoperative 3‐D CT using a 64‐row multi‐detector CT scanner, followed by laparoscopy‐assisted distal gastrectomy. The 3‐D CT images of the arterial and portal phases were reconstructed and fused. The operative outcomes were compared between patients who had not undergone 3‐D CT (2007–2008) and who had undergone 3‐D CT (2009–2011). Results According to Adachi's classification, the numbers of type I, II, III, IV, V, and VI arterial patterns were 253, 15, 1, 3, 3, and 1, respectively. Three cases could not be classified. According to the Douglass classification, the left gastric vein flowed into the portal vein, splenic vein, junction of the portal vein and splenic vein, and left branch of the portal vein in 119, 111, 36, and 5 patients, respectively. The left gastric vein could not be visualized in six patients, and two patients could not be classified. In addition, the relation was absent for an Adachi type I vein and one of the “other” types of veins. The total operative time was significantly shorter with 3‐D CT than without it ( P = 0.01), and the degree of lymph‐node dissection was significantly higher ( P = 0.01). Inflammatory parameters and operative morbidity tended to decrease with 3‐D CT. Conclusion Three‐dimensional CT is a useful modality to visualize the vessel anatomy around the stomach, and it improves clinical effectiveness and reduces the invasiveness of surgery.