Short-Term Clinical Implications of the Accessory Left Hepatic Artery in Patients Undergoing Radical Gastrectomy for Gastric Cancer
Open Access
- 23 May 2013
- journal article
- research article
- Published by Public Library of Science (PLoS) in PLOS ONE
- Vol. 8 (5), e64300
- https://doi.org/10.1371/journal.pone.0064300
Abstract
To evaluate the prevalence of the accessory left hepatic artery (ALHA; defined as a vessel arising from the left gastric artery, which, together with a typical left hepatic artery, supplies blood to the left lobe of the liver) and its short-term clinical implications in patients undergoing radical gastrectomy for gastric cancer. Clinical data of 1173 patients with gastric cancer who underwent laparoscopy-assisted radical gastrectomy were retrospectively analyzed. Groups of patients with and without ALHA were compared to identify differences in intraoperative and postoperative variables and changes in liver function. Of the 1173 patients, 135 (11.5%) had an ALHA and 1038 (88.5%) did not. There were no significant between-group differences in clinicopathological and intraoperative characteristics, postoperative recovery, and morbidity and mortality rates (P>0.05 each). None of the patients had postoperative symptoms associated with impaired liver function. Glutamic oxaloacetic transaminase (GOT), glutamic pyruvic transaminase (GPT) and total bilirubin (TBIL) concentrations were similar preoperatively. TBIL concentrations on postoperative days 1, 3, and 7 were similar (P>0.05), while GOT and GPT activities were higher in the ALHA than in the non-ALHA group on days 1 and 7 (P<0.05), with all three markers similar in the two groups on day 14. In patients without chronic liver disease (CLD), GOT, GPT and TBIL concentrations were similar in patients with and without ALHA; whereas, in patients with CLD, GOT and GPT concentrations on days 1 and 3 and GOT on day 7 were higher in patients with than without ALHA. ALHA is a common anomaly that was found in 11.5% of patients. It can be safely severed during radical gastrectomy in patients without CLD, but should be left intact in patients with CLD to prevent liver dysfunction. If severed in the latter, the patient should be monitored and liver-protecting therapy may be necessary.This publication has 28 references indexed in Scilit:
- Liver cirrhosisBest Practice & Research Clinical Gastroenterology, 2011
- Skin TumoursPublished by Wiley ,2010
- Radical Gastrectomy for Cancer of the StomachSurgical Clinics of North America, 2005
- Rare case of the inferior mesenteric artery and the common hepatic artery arising from the superior mesenteric arteryClinical Anatomy, 2004
- Surgical Anatomy of the Hepatic Arteries in 1000 CasesAnnals of Surgery, 1994
- Esophagogastrectomy and the variant left hepatic arteryThe Annals of Thoracic Surgery, 1992
- Anastomosen zwischen Segmentarterien der Leber und phrenico-hepatische arterio-arterielle AnastomosenLangenbecks Archiv für Chirurgie, 1982
- The morphology of cirrhosis. Recommendations on definition, nomenclature, and classification by a working group sponsored by the World Health Organization.Journal of Clinical Pathology, 1978
- Collateral Arterial Blood Supply of the Liver after Hepatic Artery Ligation, Angiographic Study of Twenty PatientsAnnals of Surgery, 1972
- Newer anatomy of the liver and its variant blood supply and collateral circulationThe American Journal of Surgery, 1966