Published online Jun 15, 2019. doi: 10.4251/wjgo.v11.i6.499
Peer-review started: January 9, 2019
First decision: January 18, 2019
Revised: February 27, 2019
Accepted: March 12, 2019
Article in press: March 13, 2019
Published online: June 15, 2019
Radical D2 lymphadenectomy for advanced gastric cancer as a standard procedure has gained global consensus. Mounting studies have shown that the number of lymph nodes dissection directly affects the prognosis and recurrence of gastric cancer. Our previous study showed that there was no obvious lymph node around the abnormal hepatic artery derived from the superior mesenteric artery.
To investigate the relationship between celiac artery variation and the number of lymph nodes dissection in gastric cancer surgery.
The clinicopathological data of 421 patients treated with radical D2 lymphadenectomy were analyzed retrospectively. The difference of the number of lymph nodes dissection between the celiac artery variation group and the normal vessels group and the relationship with prognosis were analyzed.
Celiac artery variation was found in 110 patients, with a variation rate of 26.13%. Celiac artery variation, tumor staging, and Borrmann typing were factors that affected lymph node clearance in gastric cancer, and the number of lymph nodes dissection in patients with celiac artery variation was significantly less than that of non-variant groups (P < 0.05). Univariate analysis showed that there was no significant difference in survival time between the two groups (P > 0.05). Univariate and multiple Cox regression analysis showed that celiac artery variation was not a prognostic factor for gastric cancer (P > 0.05). Tumor staging, intraoperative bleeding, and positive lymph node ratio were prognostic factors for gastric cancer patients (all P < 0.05).
The number of lymph nodes dissection in patients with celiac artery variation was reduced, but there was no obvious effect on prognosis. Therefore, lymph nodes around the abnormal hepatic artery may not need to be dissected in radical D2 lymphadenectomy.
Core tip:Celiac artery variation has been given great importance by surgeons. However, the distribution of the lymph nodes around the variant celiac artery and its effect on prognosis has rarely been examined. This study shows that variation of the celiac artery is an important factor affecting the lymph node clearance of gastric cancer, and the decrease in the number of lymph nodes dissection does not affect the prognosis. Therefore, lymph nodes dissection around abnormal hepatic artery, especial for the abnormal hepatic artery derived from the superior mesenteric artery, is not recommended.