title: Three-dimensional computed tomography analysis of the left gastric vein in a pancreatectomy.
abstract: BACKGROUND
  During a pancreatectomy, the left gastric vein (LGV) has an important role in the venous drainage of the stomach (total pancreatectomy, left splenopancreatectomy, pancreatoduodenectomy with venous resection and pylorus-preserving pancreaticoduodenectomy). Pre-operative knowledge of the LGV's termination is necessary for adequate protection of this vein during dissection. The objective of the present study was to analyse the location of the LGV's termination in a patient population and facilitate its identification in at-risk situations.
  
  
  METHODS
  Abdominal computed tomography (CT) images of 86 pancreatic tumour patients (20 of whom underwent surgery), who were treated in our institution between October 2009 and October 2010, were reviewed. Arterial-phase and portal-phase helical CT with three-dimensional reconstruction was performed in all cases. The location of the termination of the LGV was determined and (when the LGV merged with the splenic vein or the splenomesenteric trunk) the distance between the termination and the origin of the portal vein (PV). The correlation between CT imaging data and intra-operative findings was studied.
  
  
  RESULTS
  The LGV was identified on all CT images. In 65% of cases (n= 56), the LGV terminated in the PV (upstream of the liver in nine of these cases). The LGV terminated at the splenomesenteric trunk in 4.7% of cases (n= 4) and in the splenic vein in 30.3% of cases (n= 26). When the LGV terminated upstream of the origin of the PV, the distance between the two was always greater than 1 cm. The average distance between the termination of the LGV and the origin of the PV was 14.34 mm (10.2 to 21.1). The anatomical data from CT images agreed with the intra-operative findings in all cases.
  
  
  CONCLUSIONS
  Pre-operative analysis of the LGV is useful because the vein can be identified in all cases. Knowledge of the termination's anatomic location enables the subsequent resection to be initiated in a low-risk area.
authors.affiliation: Department of Digestive Surgery, Amiens University Hospital and Jules Verne University of Picardie, Place Victor Pauchet, Amiens, France.
authors.forename: Lionel
authors.initials: L
authors.lastname: Rebibo
authors.forename: Cyril
authors.initials: C
authors.lastname: Chivot
authors.forename: David
authors.initials: D
authors.lastname: Fuks
authors.forename: Charles
authors.initials: C
authors.lastname: Sabbagh
authors.forename: Thierry
authors.initials: T
authors.lastname: Yzet
authors.forename: Jean-Marc
authors.initials: JM
authors.lastname: Regimbeau
mesh_terms: D004210:Dissection; D005602:France; D006801:Humans; D021621:Imaging, Three-Dimensional; D007430:Intraoperative Care; D010180:Pancreatectomy / Q000009:adverse effects; D010190:Pancreatic Neoplasms / Q000098:blood supply / Q000000981:diagnostic imaging / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000009:adverse effects; D010690:Phlebography / Q000379:methods*; D011169:Portal Vein / Q000000981:diagnostic imaging; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011857:Radiographic Image Interpretation, Computer-Assisted; D013162:Splenic Vein / Q000000981:diagnostic imaging; D013270:Stomach / Q000098:blood supply*; D036542:Tomography, Spiral Computed