Journal of Gastric Cancer

The Korean Gastric Cancer Association (대한위암학회)
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Adverse Effects of Ligation of an Aberrant Left Hepatic Artery Arising from the Left Gastric Artery during Radical Gastrectomy for Gastric Cancer: a Propensity Score Matching Analysis

  • Lee, Sejin (Department of Surgery, Yonsei University College of Medicine) ;
  • Son, Taeil (Department of Surgery, Yonsei University College of Medicine) ;
  • Song, Jeong Ho (Department of Surgery, Yonsei University College of Medicine) ;
  • Choi, Seohee (Department of Surgery, Yonsei University College of Medicine) ;
  • Cho, Minah (Department of Surgery, Yonsei University College of Medicine) ;
  • Kim, Yoo Min (Department of Surgery, Yonsei University College of Medicine) ;
  • Kim, Hyoung-Il (Department of Surgery, Yonsei University College of Medicine) ;
  • Hyung, Woo Jin (Department of Surgery, Yonsei University College of Medicine)
  • Received : 2020.08.28
  • Accepted : 2021.03.12
  • Published : 2021.03.31
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Abstract

Purpose: No consensus exists on whether to preserve or ligate an aberrant left hepatic artery (ALHA), which is the most commonly encountered hepatic arterial variation during gastric surgery. Therefore, we aimed to evaluate the clinical effects of ALHA ligation by analyzing the perioperative outcomes. Materials and Methods: We retrospectively reviewed the data of 5,310 patients who underwent subtotal/total gastrectomy for gastric cancer. Patients in whom the ALHA was ligated (n=486) were categorized into 2 groups according to peak aspartate aminotransferase (AST) or alanine aminotransferase (ALT) levels: moderate-to-severe (MS) elevation (≥5 times the upper limit of normal [ULN]; MS group, n=42) and no-to-mild (NM) elevation (<5 times the ULN; NM group, n=444). The groups were matched 1:3 using propensity score-matching analysis to minimize confounding factors that can affect the perioperative outcomes. Results: The mean operation time (P=0.646) and blood loss amount (P=0.937) were similar between the 2 groups. The length of hospital stay was longer in the MS group (13.0 vs. 7.8 days, P=0.022). No postoperative mortality occurred. The incidence of grade ≥ IIIa postoperative complications (19.0% vs. 5.1%, P=0.001), especially pulmonary complications (11.9% vs. 2.5%, P=0.003), was significantly higher in the MS group. This group also showed a higher Comprehensive Complication Index (29.0 vs. 13.9, P<0.001). Conclusions: Among patients with a ligated ALHA, those with peak AST/ALT ≥5 times the ULN showed worse perioperative outcomes in terms of hospital stay and severity of complications. More precise perioperative decision-making tools are needed to better determine whether to preserve or ligate an ALHA.

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References

  1. Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 2018;68:394-424. https://doi.org/10.3322/caac.21492
  2. Japanese Gastric Cancer Association. Japanese gastric cancer treatment guidelines 2018 (5th edition). Gastric Cancer 2021;24:1-21. https://doi.org/10.1007/s10120-020-01042-y
  3. Japanese classification of gastric carcinoma: 3rd English edition. Gastric Cancer 2011;14:101-112. https://doi.org/10.1007/s10120-011-0041-5
  4. Vandamme JP, Bonte J, Van der Schueren G. A revaluation of hepatic and cystic arteries. The importance of the aberrant hepatic branches. Acta Anat (Basel) 1969;73:192-209. https://doi.org/10.1159/000143296
  5. Naidich JB, Naidich TP, Sprayregen S, Hyman RA, Pudlowski RM, Stein HL. The origin of the left gastric artery. Radiology 1978;126:623-626. https://doi.org/10.1148/126.3.623
  6. Michels NA. Newer anatomy of the liver and its variant blood supply and collateral circulation. Am J Surg 1966;112:337-347. https://doi.org/10.1016/0002-9610(66)90201-7
  7. Plengvanit U, Chearanai O, Sindhvananda K, Dambrongsak D, Tuchinda S, Viranuvatti V. Collateral arterial blood supply of the liver after hepatic artery ligation, angiographic study of twenty patients. Ann Surg 1972;175:105-110. https://doi.org/10.1097/00000658-197201000-00016
  8. Covey AM, Brody LA, Maluccio MA, Getrajdman GI, Brown KT. Variant hepatic arterial anatomy revisited: digital subtraction angiography performed in 600 patients. Radiology 2002;224:542-547. https://doi.org/10.1148/radiol.2242011283
  9. Shinohara T, Ohyama S, Muto T, Yanaga K, Yamaguchi T. The significance of the aberrant left hepatic artery arising from the left gastric artery at curative gastrectomy for gastric cancer. Eur J Surg Oncol 2007;33:967-971. https://doi.org/10.1016/j.ejso.2007.02.030
  10. Douard R, Chevallier JM, Delmas V, Cugnenc PH. Laparoscopic detection of aberrant left hepatic artery: a prospective study in 300 consecutive patients. Surg Radiol Anat 2006;28:13-17. https://doi.org/10.1007/s00276-005-0008-5
  11. Okano S, Sawai K, Taniguchi H, Takahashi T. Aberrant left hepatic artery arising from the left gastric artery and liver function after radical gastrectomy for gastric cancer. World J Surg 1993;17:70-73. https://doi.org/10.1007/bf01655708
  12. Jaillette E, Girault C, Brunin G, Zerimech F, Chiche A, Broucqsault-Dedrie C, et al. French Intensive Care Society, International congress - Reanimation 2016. Ann Intensive Care 2016;6:50. https://doi.org/10.1186/s13613-016-0114-z
  13. Ang RR, Lee HJ, Bae JS, Zhu CC, Berlth F, Kim TH, et al. Safety of ligation of aberrant left hepatic artery originating from left gastric artery in laparoscopic gastrectomy for gastric cancer. Sci Rep 2020;10:5856. https://doi.org/10.1038/s41598-020-62587-7
  14. Kwo PY, Cohen SM, Lim JK. ACG clinical guideline: evaluation of abnormal liver chemistries. Am J Gastroenterol 2017;112:18-35. https://doi.org/10.1038/ajg.2016.517
  15. Adachi B, Hasebe K. Das Arteriensystem der Japaner, Vol. 2. Tokyo: Kenkyuhsa Press; 1928.
  16. Chen H, Yano R, Emura S, Shoumura S. Anatomic variation of the celiac trunk with special reference to hepatic artery patterns. Ann Anat 2009;191:399-407. https://doi.org/10.1016/j.aanat.2009.05.002
  17. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 2004;240:205-213. https://doi.org/10.1097/01.sla.0000133083.54934.ae
  18. Slankamenac K, Graf R, Barkun J, Puhan MA, Clavien PA. The comprehensive complication index: a novel continuous scale to measure surgical morbidity. Ann Surg 2013;258:1-7. https://doi.org/10.1097/SLA.0b013e318296c732
  19. Lurie AS. The significance of the variant left accessory hepatic artery in surgery for proximal gastric cancer. Arch Surg 1987;122:725-728. https://doi.org/10.1001/archsurg.1987.01400180107021
  20. Hemming AW, Finley RJ, Evans KG, Nelems B, Fradet G. Esophagogastrectomy and the variant left hepatic artery. Ann Thorac Surg 1992;54:166-168. https://doi.org/10.1016/0003-4975(92)91173-7
  21. Mays ET, Wheeler CS. Demonstration of collateral arterial flow after interruption of hepatic arteries in man. N Engl J Med 1974;290:993-996. https://doi.org/10.1056/NEJM197405022901804
  22. Huang CM, Chen QY, Lin JX, Zheng CH, Li P, Xie JW, et al. Short-term clinical implications of the accessory left hepatic artery in patients undergoing radical gastrectomy for gastric cancer. PLoS One 2013;8:e64300. https://doi.org/10.1371/journal.pone.0064300
  23. de la Plaza Llamas R, Hidalgo Vega Á, Latorre Fragua RA, López Marcano AJ, Medina Velasco AA, Diaz Candelas DA, et al. The cost of postoperative complications and economic validation of the comprehensive complication index: prospective study. Ann Surg 2021;273:112-120. https://doi.org/10.1097/SLA.0000000000003308
  24. Shimizu S, Saito H, Kono Y, Murakami Y, Shishido Y, Miyatani K, et al. The prognostic significance of the comprehensive complication index in patients with gastric cancer. Surg Today 2019;49:913-920. https://doi.org/10.1007/s00595-019-01828-3
  25. Tu RH, Lin JX, Li P, Xie JW, Wang JB, Lu J, et al. Comprehensive complication index predicts cancer-specific survival of patients with postoperative complications after curative resection of gastric cancer. Gastroenterol Res Pract 2018;2018:4396018. https://doi.org/10.1155/2018/4396018
  26. Kim J, Kim SM, Seo JE, Ha MH, An JY, Choi MG, et al. Should an aberrant left hepatic artery arising from the left gastric artery be preserved during laparoscopic gastrectomy for early gastric cancer treatment? J Gastric Cancer 2016;16:72-77. https://doi.org/10.5230/jgc.2016.16.2.72
  27. Suda K, Takeuchi H, Ishizaka A, Kitagawa Y. High-mobility-group box chromosomal protein 1 as a new target for modulating stress response. Surg Today 2010;40:592-601. https://doi.org/10.1007/s00595-009-4232-1