The significance of the aberrant left hepatic artery arising from the left gastric artery at curative gastrectomy for gastric cancer.
BACKGROUND
An aberrant left hepatic artery (ALHA) is occasionally encountered during esophagogastric surgery. However, at curative gastrectomy for gastric cancer, it is questionable as to whether the ALHA need to be divided in order to maximize lymph node clearance and the issue requires clarification.


METHODS
We encountered 50 patients with an ALHA during curative gastrectomy for gastric cancer between 1997 and 2001. Data concerning operative feasibility, postoperative liver function and therapeutic value of nodal dissection were analyzed retrospectively.


RESULTS
For 27 patients, we preserved the ALHA, and for the remaining 23 patients, we divided the ALHA at the origin of the left gastric artery (LGA). Serum levels of aspartate aminotransferase and alanine aminotransferase were statistically significant higher on postoperative day (POD) 1 (P=0.0008 and P=0.0007), and on POD 3 (P=0.001 and P=0.008), respectively, in the ALHA-divided group. Patients who underwent a total gastrectomy predominated in the ALHA-divided group, the total number of dissected lymph nodes being higher in the ALHA-divided group (P=0.018). However, the total numbers of dissected lymph nodes and metastatic lymph nodes around the LGA were similar in the 2 groups (P=0.447 and P=0.128), respectively. No significant differences were seen between the 2 groups in morbidity and mortality. The overall 5-year survival rates were also comparable.


CONCLUSIONS
Although a prospective study is required, this study suggested that routine division of the ALHA may not always be required for curative gastrectomy.
Shinohara
T
T
Department of Gastrointestinal Surgery, Cancer Institute Hospital, Tokyo, Japan. shinohara@jikei.ac.jp
Ohyama
S
S
Muto
T
T
Yanaga
K
K
Yamaguchi
T
T
D000328:Adult; D000368:Aged; D000410:Alanine Transaminase / Q000097:blood; D001219:Aspartate Aminotransferases / Q000097:blood; D005240:Feasibility Studies; D005260:Female; D005743:Gastrectomy / Q000379:methods*; D006499:Hepatic Artery / Q000002:abnormalities* / Q000601:surgery*; D006801:Humans; D008197:Lymph Node Excision; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013270:Stomach / Q000098:blood supply / Q000601:surgery*; D013274:Stomach Neoplasms / Q000601:surgery*; D016896:Treatment Outcome
D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase