Three-dimensional CT for preoperative detection of the left gastric artery and left gastric vein in laparoscopy-assisted distal gastrectomy.
BACKGROUND
We evaluated 3-D CT imaging for preoperative classification of the left gastric artery and vein in patients with early gastric cancer and estimated its clinical benefit.


METHODS
Between April 2009 and March 2014, 279 patients underwent preoperative 3-D CT using a 64-row multi-detector CT scanner, followed by laparoscopy-assisted distal gastrectomy. The 3-D CT images of the arterial and portal phases were reconstructed and fused. The operative outcomes were compared between patients who had not undergone 3-D CT (2007-2008) and who had undergone 3-D CT (2009-2011).


RESULTS
According to Adachi's classification, the numbers of type I, II, III, IV, V, and VI arterial patterns were 253, 15, 1, 3, 3, and 1, respectively. Three cases could not be classified. According to the Douglass classification, the left gastric vein flowed into the portal vein, splenic vein, junction of the portal vein and splenic vein, and left branch of the portal vein in 119, 111, 36, and 5 patients, respectively. The left gastric vein could not be visualized in six patients, and two patients could not be classified. In addition, the relation was absent for an Adachi type I vein and one of the "other" types of veins. The total operative time was significantly shorter with 3-D CT than without it (P = 0.01), and the degree of lymph-node dissection was significantly higher (P = 0.01). Inflammatory parameters and operative morbidity tended to decrease with 3-D CT.


CONCLUSIONS
Three-dimensional CT is a useful modality to visualize the vessel anatomy around the stomach, and it improves clinical effectiveness and reduces the invasiveness of surgery.
Department of Digestive Surgery, Tokushima Red Cross Hospital, Komatsushima City, Japan.
Yasuhiro
Y
Yuasa
Department of Digestive Surgery, Tokushima Red Cross Hospital, Komatsushima City, Japan.
Hiroshi
H
Okitsu
Department of Digestive Surgery, Tokushima Red Cross Hospital, Komatsushima City, Japan.
Masakazu
M
Goto
Department of Digestive Surgery, Tokushima Red Cross Hospital, Komatsushima City, Japan.
Shunsuke
S
Kuramoto
Department of Digestive Surgery, Tokushima Red Cross Hospital, Komatsushima City, Japan.
Atsushi
A
Tomibayashi
Department of Digestive Surgery, Tokushima Red Cross Hospital, Komatsushima City, Japan.
Daisuke
D
Matsumoto
Department of Digestive Surgery, Tokushima Red Cross Hospital, Komatsushima City, Japan.
Hiroshi
H
Edagawa
Department of Digestive Surgery, Tokushima Red Cross Hospital, Komatsushima City, Japan.
Osamu
O
Mori
Department of Digestive Surgery, Tokushima Red Cross Hospital, Komatsushima City, Japan.
Ryotaro
R
Tani
Department of Radiology, Tokushima Red Cross Hospital, Komatsushima City, Japan.
Takuya
T
Akagawa
Department of Radiology, Tokushima Red Cross Hospital, Komatsushima City, Japan.
Mitsuhiro
M
Kinoshita
Department of Radiology, Tokushima Red Cross Hospital, Komatsushima City, Japan.
Yoko
Y
Akagawa
Department of Radiology, Tokushima Red Cross Hospital, Komatsushima City, Japan.
Hayato
H
Tani
Department of Radiology, Tokushima Red Cross Hospital, Komatsushima City, Japan.
Norio
N
Ohnishi
Department of Radiology, Tokushima Red Cross Hospital, Komatsushima City, Japan.
Ryozo
R
Shirono
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002445:Celiac Artery / Q000000981:diagnostic imaging; D005260:Female; D005743:Gastrectomy / Q000379:methods; D006801:Humans; D021621:Imaging, Three-Dimensional; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography / Q000379:methods*; D011300:Preoperative Care / Q000379:methods*; D012189:Retrospective Studies; D013270:Stomach / Q000098:blood supply* / Q000000981:diagnostic imaging / Q000601:surgery; D013274:Stomach Neoplasms / Q000601:surgery*; D016896:Treatment Outcome; D014680:Veins / Q000000981:diagnostic imaging
Laparoscopy; multi-detector computed tomography; stomach neoplasm