Left gastric and right hepatic artery anomalies in a patient with gastric cancer: images for surgeons

• Published in: The American journal of surgery 2011-08, Vol.202 (2), p.e13-e16
• Main Authors: Celik, Atilla, M.D, Celik, Aysun Simsek, M.D, Altinli, Ediz, M.D, Beykal, Omer, M.D, Caglayan, Kasim, M.D, Koksal, Neset, M.D
• Format: Article
• Language: English
• Subjects: Abdomen; Adenocarcinoma - blood supply; Adenocarcinoma - diagnostic imaging; Adenocarcinoma - pathology; Adenocarcinoma - surgery; Anastomosis, Roux-en-Y; Angiography; Anomalies; Aorta; Arteries - abnormalities; Biopsy; Cancer; Chemotherapy; Computation; Computed tomography; Construction; Coronary vessels; Decision making; Diagnostic systems; Dissection; Gangrene; Gastrectomy; Gastrectomy - methods; Gastric cancer; Hepatic artery; Hepatic Artery - abnormalities; Hepatic Artery - diagnostic imaging; Hepatic Artery - surgery; Humans; Identification methods; Laparotomy; Liver; Lymph Node Excision; Lymph nodes; Lymph Nodes - diagnostic imaging; Lymph Nodes - pathology; Lymphatic Metastasis; Lymphatic system; Male; Medical imaging; Medical personnel; Metastasis; Middle Aged; Multidetector-row computed tomography scan; Neoplasm Staging; Patients; Preoperative Period; Preoperative staging; Splenectomy; Stomach; Stomach - blood supply; Stomach Neoplasms - blood supply; Stomach Neoplasms - diagnostic imaging; Stomach Neoplasms - pathology; Stomach Neoplasms - surgery; Surgeons; Surgery; Therapy; Tomography; Tomography, X-Ray Computed - instrumentation; Vascular anomaly; Vascular Surgical Procedures - methods; Veins & arteries
• ISSN: 0002-9610; 1879-1883
• DOI: 10.1016/j.amjsurg.2010.04.028

Abstract Background Surgical resection remains the principal treatment for advanced gastric cancer, but one of the difficulties in a curative or extended gastrectomy is the identification of the vascular supply of the stomach. Methods A patient had gastric cancer hospitalized for planning and performing his surgical therapy. A multidetector-row computed tomography scan showed us a large tumor mass and numerous lymph nodes invading perigastric and second tiers of stomach and revealed a left gastric artery and right hepatic artery in which branched directly from aorta. A 3-dimensional construction showed a demonstrative vascular anomaly as well during operation. Result We were able to perform total gastrectomy and D2 lymph node dissection as surgical therapy for patient. The patient's postoperative clinical course was uneventful, and after postoperative 36 months, there was no evidence of recurrence. Conclusion We recommend that a multidetector-row computed tomography scan is very useful for the preoperative staging in gastric cancer patients because of its diagnostic value for showing any vascular anomaly and aiding in decision making on the appropriate surgical strategy.