Laparoscopic distal gastrectomy with preservation of the cranial hepatic artery in gastric cancer patients: technical aspects
Abstract
Gastric cancer is one of the most common human malignancies with poor prognosis. The main
modality of treatment in patients with early stage gastric cancer is still surgery. The introduction
of new visualization systems, reliable and ergonomic endostaplers and more experience in the last
20 years led to an increase in the indications for less invasive surgical approaches in cancer patients. The most common laparoscopic surgical procedure in gastric cancer is laparoscopic subtotal
gastrectomy. Adequate lymph node dissection displays certain difficulties in laparoscopic surgeries that are related to troubles in lymph node exposition in the resectable areas as well as with certain
features of endoscopic instruments. Even more difficulties arise in anatomic variations of the celiac
artery and liver blood supply. In almost 16% of all cases a large aberrant artery, supplying not only
the stomach, but also the left lobe of the liver, is located in between omentum sheets. In all cases
where the artery has a hemodynamically significant caliber it must be preserved without compromising the volume of the gastric resection or lymph node dissection.
In this article we present certain technical aspects of performing laparoscopic distal gastrectomy
with preservation of the cranial hepatic artery.
Keywords:laparoscopic distal gastrectomy, gastric cancer, laparoscopic D2 lymph node dissection, cranial hepatic artery
Clin. Experiment. Surg. Petrovsky J. 2016. № 4. Р. 39–47.
Received: 15.09.2016. Accepted: 27.10.2016.
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