VIDEOLAPAROSCOPIC DII LYMPHENCTOMY WITH PRESERVATION OF HEPATIC ARTERY LEFT ACCESSORY IN PATIENT WITH GASTRIC ADENOCARCINOMA

Introduction: Proper knowledge of anatomical variations within the upper abdomen is essential for performing surgical procedures. The range of anatomical variations is reported in the literature. Preoperative arterial imaging is of paramount importance for surgical planning involving the upper abdominal organs. Injuries to the hepatic arterial supply are more prone to hepatocellular damage and subsequent liver failure. Hepatic artery originated from the celiac trunk in 52 to 76% of individuals, and variations in normal hepatic artery anatomy are found in 32 to 48% of patients. About 10% of patients may have an accessory left hepatic artery branch of the left gastric artery. Objective: To report a case of a patient with gastric adenocarcinoma who underwent subtotal gastrectomy with IBD lymphadenectomy with preservation of the accessory left hepatic artery. Materials and Methods: This is a 36-year-old obese patient, ASA II, who had abdominal pain for about 2 months, which made her look for a gastroenterologist who continued investigation with upper digestive endoscopy (EDA). The examination showed a 1.5cm lesion in large distal gastric body curvature, in which the biopsy revealed gastric adenocarcinoma. Staging exams (chest, abdomen and pelvic tomography) did not reveal distant disease (cT1 / 2N0Mx). The patient underwent Upfront surgery with subtotal gastrectomy, IBD lymphadenectomy with preservation of the left hepatic artery accessory branch of the left gastric artery, without final oncological involvement. Results: The patient evolved well and was discharged on the 5th postoperative day. The pathology revealed poorly differentiated adenocarcinoma, the neoplasia was 2.0 x 1.0 cm, with invasion depth to the submucosa, free margins and 34 dissected and examined lymph nodes, all free of neoplasia (pT1bN0). Conclusion: Knowledge of the anatomical variations of the hepatic blood supply is necessary for safe surgical performance. Systematic lymphadenectomy is necessary for proper cancer treatment. Preservation of the hepatic arterial supply is extremely important since inadvertent injury to these vessels can irreversibly compromise organ function.

Publication History

Article published online:
23 October 2019