Preoperative assessment of perigastric vascular anatomy by multidetector computed tomography angiogram for laparoscopy-assisted gastrectomy

• Published in: Langenbeck's archives of surgery 2012-08, Vol.397 (6), p.945-950
• Main Authors: Miyaki, Akira, Imamura, Kazuhiro, Kobayashi, Rie, Takami, Makoto, Matsumoto, Jun, Takada, Yukari
• Format: Article
• Language: English
• Subjects: Abdominal Surgery; Adult; Aged; Aged, 80 and over; Angiography - methods; Cardiac Surgery; Cohort Studies; Disease-Free Survival; Female; Follow-Up Studies; Gastrectomy - methods; Gastroscopy - methods; General Surgery; Humans; Laparoscopy - methods; Male; Medicine; Medicine & Public Health; Middle Aged; Multidetector Computed Tomography - methods; Neoplasm Invasiveness - pathology; Neoplasm Staging; Original Article; Preoperative Care - methods; Retrospective Studies; Risk Assessment; Stomach - blood supply; Stomach Neoplasms - diagnostic imaging; Stomach Neoplasms - mortality; Stomach Neoplasms - pathology; Stomach Neoplasms - surgery; Survival Analysis; Thoracic Surgery; Traumatic Surgery; Treatment Outcome; Vascular Surgery
• ISSN: 1435-2443; 1435-2451
• DOI: 10.1007/s00423-012-0956-2

Purpose We aimed at investigating the efficacy of multidetector computed tomography (MDCT) angiogram reconstructed using the maximum intensity projection (MIP) technique for the assessment of perigastric vascular anatomy before laparoscopy-assisted gastrectomy (LAG) for gastric cancer. Methods Seventy-one patients who underwent LAG were enrolled in the study. Contrast-enhanced scans of the portal venous phase were performed by a MDCT scanner. The CT images were reconstructed using thin-slab MIP. The anatomic variations in the inflow and the location of the left gastric vein (LGV) were detected. The patterns of perigastric arterial origins were divided according to Michels' classification. The intraoperative blood loss on LAG was compared before and after MDCT angiography was introduced in the study. Results The LGV flowed into the portal vein in 31 patients; the splenic vein, 25 patients; and the junction of these two veins, 15 patients. The LGV passed to the dorsal and ventral sides of the common hepatic artery in 30 and 13 patients and to the dorsal and ventral sides of the splenic artery in 8 and 20 patients, respectively. Michels' type II was found in one patient; type V, in three patients; and type VI, in two patients. The LGV location detected by MDCT was confirmed during surgery in all cases. Intraoperative blood loss after introduction of the MDCT angiography was significantly less than that before its introduction ( p  = 0.0032). Conclusions An MDCT angiogram reconstructed using the MIP technique is effective for assessing the perigastric vascular anatomy before LAG for gastric cancer.