Application Of Preoperative Three-Dimensional CT Angiography In Laparoscopic Radical Gastrectomy For Gastric Cancer

Background:As an important part of laparoscopic radical gastrectomy for gastric cancer,the thoroughness of lymph node dissection directly affects the accuracy of postoperative pathological staging and long-term survival of patients.The anatomical features of lymph nodes that are predominantly vascularized determine the importance of vascular management during surgery.In addition,there are not only a large number of perigastric arteries,but also a high mutation rate.In addition,there is a disadvantage that the blood vessels cannot be directly sensed by hand during laparoscopic surgery,which makes lymph node dissection a difficult and time-consuming high-risk surgical step in laparoscopic radical gastrectomy for gastric cancer.On the premise of not damaging the blood vessels,in order to ensure the completeness of lymph node dissection as much as possible,it is particularly important to accurately assess the anatomical relationship of the perigastric blood vessels before surgery.However,traditional imaging examinations such as CT imaging cannot accurately display the anatomical course of the perigastric artery.Based on this,we intend to perform three-dimensional imaging of the anatomy of the perigastric artery through preoperative three-dimensional CT angiography(CTA),and guide the course of the artery during the operation.To evaluate the application value of three-dimensional CT angiography(CTA)technology in laparoscopic radical gastrectomy for gastric cancer.Objective:To investigate the clinical value and significance of preoperative 3D CT angiography(CTA)in laparoscopic radical gastrectomy for gastric cancer.Methods:Clinical data of 214 patients with gastric cancer undergoing laparoscopic radical gastrectomy were prospectively collected and retrospectively analyzed.We divided the patients into groups according to the criterion of preoperative CTA examination,and compared the basic characteristic data of the CTA group and the non-CTA group.Propensity score matching was conducted according to all features,and the intraoperative and postoperative clinical observation indexes of matched groups were compared.In addition,subgroup analysis was established in the CTA group,which was divided into groups based on whether the intraoperative indolyanine green(ICG)fluorescent laparoscopy was used,and the intraoperative clinical observation indexes were compared after propensity score matching.In addition,CTA 3D image data of patients in the CTA group were collected and analyzed.The celiac trunk and hepatic artery were classified according to Adachi classification standard and Hiatt classification standard respectively.At the same time,we established a new classification of splenic artery risk based on surgical risk factors and anatomic vascular configuration.Finally,the gastric peripheral arteries,such as celiac trunk,hepatic artery,splenic artery and its branches,were classified to analyze the special vascular course and vascular variation.Results:According to Adachi classification,the celiac trunk was divided into Type Ⅰ(118/125,94.4%),Type Ⅱ(3/125,2.4%),Type Ⅲ(0/125,0%)Type Ⅳ(1/125,0.8%),Type Ⅴ(2/125,1.6%)and Type Ⅵ(1/125,0.8%).Hepatic artery classification according to Hiatt:Type Ⅰ(102/125,81.6%),and Type Ⅱ(9/125,7.2%),Type Ⅲ(6/125,4.8%),Type Ⅳ(2/125,1.6%),the Type Ⅴ(3/125,2.4%),the Type Ⅵ(0,0%),Others(3/125,2.4%).The new classification of splenic artery includes ten types,which can be divided into three categories according to risk:Severe risk type:Ⅱa(1.6%)3 Ⅲa(5.6%).Moderate risk type:Ⅱb(35.2%)Ⅲb(10.4%),Va(0.8%),Ⅵa(7.2%).Low risk type:I(1.6%),Ⅳ(0.8%),Vb(28.0%),VIb(8.8%).The results showed that the operation time and estimated blood loss in the CTA group were significantly lower than those in the non-CTA group,and the first exhaust time after operation in the CTA group was significantly earlier than that in the non-CTA group.In addition,in the CTA group,the blood loss of the combined ICG green-labeled fluoroscopy group was significantly lower than that of the non-ICG green-labeled fluoroscopy group.Conclusions:Preoperative CTA for laparoscopic radical gastrectomy of gastric cancer can objectively assess vascular pathways and changes in patients,thus helping us avoid or reduce the risk of vascular injury and bleeding during surgery,shorten the operation time and improve patients’ postoperative recovery to a certain extent.Combined with ICG-labeled fluorescent laparoscopy,the risk of intraoperative bleeding and iatrogenic injury can be further reduced.