The Clinical Outcomes Of Gastric Cancer Patients Based On A Proposal For A Novel Classification Of Perigastric Arteries

Background The blood supply of stomach mainly originates from Celiac artery and its branches.The main branches of Celiac artery include the Common hepatic artery,the Left gastric artery and the Splenic artery.And there are many variations and collaterals of the Celiac artery.The name of the perigastric lymph nodes was based on the perigastric arteries,while the dissection of the lymph nodes was based on the arterial route.Preoperative assessment of the variation of the perigastric artery is important for planning and performing lymph node dissection,especially for laparoscopic and robotic-assisted radical gastrectomy,where the surgeon has limited field of vision and can not touch the surgical area directly.Purpose To establish a novel classification of perigastric arteries by computerized tomography angiography(CTA)and discuss its influence in patients’ clinical outcomes.Methods The clinical data of 680 patients with gastric cancer undergoing laparoscopic/robot-assisted radical gastrectomy from January 2015 to December 2017 in the affiliated hospital of Qingdao University were analyzed retrospectively.CTA was performed in 343 patients to assess the perigastric arteries before surgery.The types of the perigastric artery were classified according to CTA image and the probability of each type was calculated.And we compared the clinical outcomes between CTA group and non-CTA group.Statistical bias was reduced by using propensity score matching.Indices included intraoperative blood loss,the number of dissected lymph nodes(LNs),average operation time,intraoperative vascular injury,postoperative hospital stay,hospitalization costs,postoperative complications,30-day readmission rates,mortality and 2-year overall survival.Results The perigastric arteries can be divided into seven categories.Type I,trifurcation of the celiac trunk(CT)(294/343,85.7%);type II,hepatosplenic trunk,left gastric artery(LGA)arising from the abdominal aorta(8/343,2.3%);type III,hepatogastric trunk,splenic artery arising from the superior mesenteric artery(SMA)(2/343,0.6%);type IV,celiacomesenteric trunk(5/343,1.5%);type V,common hepatic artery(CHA)arising from the SMA,gastrosplenic trunk(11/343,3.2%);type VI,aberrant(accessory or replaced)left hepatic artery arising from LGA(21/343,6.1%);and type VII,CHA arising from LGA(2/343,0.6%).Among them,IV,V,VI,VII have potential risks of intraoperative vascular injury,considered as the high-risk classification.The number of retrieved LNs in the CTA group was significantly higher than that in the non-CTA group(33.6±12.2 vs 31.2±13.8,P= 0.033).However,the operation time,estimated blood loss,intraoperative vascular injury,and medical cost of the CTA group were significantly less than those in the non-CTA group(192.8±37.3min vs 207.4±42.5min,72.5±66.4 ml vs 93.5±88.4ml,0.4% vs 3.2%,￥88265.3±25726.1 vs ￥96591.4±31410.9,P <0.05).The 2-year overall survival of CTA Group was higher than that of non-CTA group,but there was no significant difference(86.3% vs 84.1%,P=0.268).Of note,in patients with BMI ≥ 25.0,higher LNs retrieval and less vascular injury were still present in the CTA group(32.2±10.7 vs 28.7±13.1,0.8% vs 6.0%,P<0.05),which was of vital importance in clinical practice.Furthermore,the CTA group displayed shorter postoperative hospital stay(8.6±5.3d vs 11.5±10.3d,P=0.008).The 2-year overall survival of CTA Group was higher than that of non-CTA group,but there was no significant difference(92.4% vs 87.4%,P=0.212).Conclusion We established a new perigastric artery classification.Application of the classification can improve the short-term clinical outcomes of patients.And its effect on long-term prognosis remains to be further studied.