Retrospective Study
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Jun 15, 2019; 11(6): 499-508
Published online Jun 15, 2019. doi: 10.4251/wjgo.v11.i6.499
Relationship between celiac artery variation and number of lymph nodes dissection in gastric cancer surgery
Guang-Chuan Mu, Yuan Huang, Zhi-Ming Liu, Zhi-Bai Chen, Xiang-Hua Wu, Xin-Gan Qin, Yan-Jun Zeng
Guang-Chuan Mu, Yuan Huang, Zhi-Bai Chen, Xiang-Hua Wu, Xin-Gan Qin, Department of Gastrointestinal Surgery, the First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China
Zhi-Ming Liu, Department of General Surgery, the Second Affiliated Hospital of Guangxi Medical University, Nanning 530000, Guangxi Zhuang Autonomous Region, China
Yan-Jun Zeng, Biomechanics and Medical Information Institute, Beijing University of Technology, Beijing 100124, China
Author contributions: Huang Y designed this study; Liu ZM, Wu XH, Qin XG, Chen ZB, and Zeng YJ conducted the study; Huang Y, Mu GC, and Chen ZB collected the data; Mu GC and Chen ZB interpreted the results; Mu GC and Huang Y drafted the article; Liu ZM revised the paper; All authors are in agreement with the content of the manuscript.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of the First Affiliated Hospital of Guangxi Medical University.
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: All authors declare no conflicts-of-interest related to this article.
Open-Access: This article is an open-access article thatwas selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Yuan Huang, MD, Professor, Surgeon, Department of Gastrointestinal Surgery, the First Affiliated Hospital of Guangxi Medical University, No. 6 Shuangyong Street, Nanning 530021, Guangxi Zhuang Autonomous Region, China. huangyuan_09@163.com
Telephone: +86-771-5356701 Fax:+86-771-5356559
Received: January 9, 2019
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
Processing time: 157 Days and 1.5 Hours
Abstract
BACKGROUND

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.

AIM

To investigate the relationship between celiac artery variation and the number of lymph nodes dissection in gastric cancer surgery.

METHODS

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.

RESULTS

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).

CONCLUSION

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.

Keywords: Gastric cancer; Celiac artery variation; Lymphadenectomy; Number of lymph nodes; Prognosis

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.