Influence of the visceral vessels structure variations on peculiarity of radical surgical treatment of stomach cancer

Introduction: Optimization of the choice of diagnostic volume, adequate lymphodissection in patients with stomach cancer. Methods: On the basis of the Department of Oncology and Radiology of the Tashkent Medical Academy, multislice computed tomography is performed in angio-graphic mode for all patients suffering from stomach cancer, followed by a three-dimensional reconstruction of the main vessels. After the research, the preoperative planning of the operation is carried out. With the application of this method, 224 patients were examined. For radical surgical treatment, 125 patients were selected, while in 36 of them a variant anatomy of the visceral vessels of the upper abdominal wall was revealed. Given a thorough preoperative examination, all patients were radically operated in the volume of gastrectomy or distal subtotal resection of the stomach, lymphodissection in the volume of D2 and D2 + was performed. Results: In multislice computed tomography of the abdominal cavity in angiographic mode with subsequent three-dimensional modeling, one patient was identified with significant variations: all arteries of the celiac trunk separated from the aorta; the left hepatic artery (LHA) and the splenic artery moved away from the aorta, the right hepatic artery (RHA) retreated from the celiac trunk, the left gastric artery (LGA) receded from the LHA; The celiac trunk (СT) is represented by the RHA bifurcation and the splenic artery, the LHA moved away from the aorta, the LGA departed from the LHA; CT is represented by RHA bifurcation and splenic artery, LHA receded from the splenic artery, LGA departed from the LHA; The CT is represented by bifurcation of the LGA and splenic artery, the common hepatic artery (CHA) is receding from the superior mesenteric artery (SMA). In 1 case, a single celiac-mesenteric trunk was identified. In 2 patients, the CHA or splenic artery (1 patient) moved away from the aorta. In 4 patients, CT was represented by bifurcation of CHA and splenic artery, LGA departed from the aorta. In 4 cases, a cranial LHA was detected, which departs from the CT, followed by the withdrawal of the LGA. In 3 cases, the RHA was withdrawn from the SMA and there was an aberrant LHA that departed from the CT, followed by the withdrawal of the LGA. After all the operations, the lymph nodes were labeled according to the classification of the Japanese Association for the Treatment of Stomach Cancer (JGCA, 2010). In all operated patients, there were no specific complications associated with the volume of lymph node dissection. Conclusion: Performing multislice CT in angiographic mode at the preoperative stage is an effective way of visualization of the main vessels, which allows planning the volume and technique of surgical intervention depending on the revealed vascular variation, reducing the risks of intraoperative complications, more accurately performing lymphodissection and thus achieving greater radical surgical intervention.

Перевод пока недоступен