Published online Jun 14, 2015. doi: 10.3748/wjg.v21.i22.6944
Peer-review started: January 9, 2015
First decision: January 22, 2015
Revised: February 27, 2015
Accepted: April 3, 2015
Article in press: April 3, 2015
Published online: June 14, 2015
Processing time: 160 Days and 17.2 Hours
AIM: To investigate celiac artery variations in gastric cancer patients and the impact on gastric cancer surgery, and also to discuss the value of the ultrasonic knife in reducing the risk caused by celiac artery variations.
METHODS: A retrospective analysis was conducted to investigate the difference in average operation time, intraoperative blood loss, number of harvested lymph nodes, average postoperative drainage within 3 d, and postoperative hospital stay between the group with vascular variations and no vascular variations, and between the ultrasonic harmonic scalpel and conventional electric scalpel surgery group.
RESULTS: One hundred and fifty-eight cases presented with normal celiac artery, and 80 presented with celiac artery variation (33.61%). The average operation time, blood loss, average drainage within 3 d after surgery in the celiac artery variation group were significantly more than in the no celiac artery variation group (215.7 ± 32.7 min vs 204.2 ± 31.3 min, 220.0 ± 56.7 mL vs 163.1 ± 52.3 mL, 193.6 ± 41.4 mL vs 175.3 ± 34.1 mL, respectively, P < 0.05). In celiac artery variation patients, the average operation time, blood loss, average drainage within 3 d after surgery in the ultrasonic harmonic scalpel group were significantly lower than in the conventional electric scalpel surgery group (209.5 ± 34.9 min vs 226.9 ± 29.4 min, 207.5 ± 57.1 mL vs 235.6 ± 52.9 mL, 184.4 ± 38.2 mL vs 205.0 ± 42.9 mL, respectively, P < 0.05), and the number of lymph node dissections was significantly higher than in the conventional surgery group (25.5 ± 9.2 vs 19.9 ± 7.8, P < 0.05).
CONCLUSION: Celiac artery variation increases the difficulty and risk of radical gastrectomy. Preoperative imaging evaluation and the application of ultrasonic harmonic scalpel are conducive to radical gastrectomy.
Core tip: Celiac artery variation is quite common in gastric cancer patients, and may obviously increase the difficulty and risk of radical gastrectomy with D2 lymphadenectomy. With the development of imaging techniques, not only the accuracy of preoperative staging, but also the individualized image information about celiac artery variation will be improved. Meanwhile, the application of new technology such as ultrasonic harmonic scalpel is conducive to radical gastrectomy with D2 lymphadenectomy and could reduce the risk caused by celiac artery variation; therefore, its utilization is to be recommended.