Total Laparoskopik Distal Gastrektomi, D2 Diseksiyon, Roux-en-Y Gastro- jejunostomi ve Aberran Sol Hepatik Arter: Olgu Sunumu

Gastrik kanser, tüm dünyada yaygın olarak görülen bir kanser türüdür ve kansere bağımlı ölümlerin sık rastlanan sebeplerinden biridir. Birden çok yöntemi içeren ve hedefe yönelik tedavilerdeki son gelişmelere rağmen, komplet gastrik rezeksiyon ve D2 lenf nodu diseksiyonu, karşımızda kür amacı güdebilen tek tedavi seçeneği olarak durmaktadır. Son zamanlarda laparoskopik yöntem gastrik kanser cerrahisinde açık tekniğe alternatif olarak kullanılmaktadır. Laparoskopik distal gastrektomi ve D2 diseksiyonun başarılı bir şekilde uygulanabilmesi için anatomik karakteristiklerin bilinmesi kadar, gastrik vasküler anatomik varyasyonların anlaşılmasına da ihtiyaç vardır. Bu makalede biz aberran sol hepatik arteri olan gastrik kanserli hastada uygulamış olduğumuz laparoskopik subtotal gastrektomi, D2 lenf nodu diseksiyonu ve Roux-en-Y gastro-jejunostomi tecrübemizi sunmak istiyoruz

Totally Laparoscopic Subtotal Gastrectomy (D2+) with Jejunal Roux-en-Y Reconstruction and Aberrant Left Hepatic Artery: A Case Report

Gastric cancer is a common malignancy worldwide and a common cause of cancer death. Despite recent advances in multimodal treatment and targeted therapy, complete gastric resection and D2 lymph node dissection remain the only treatment that can lead to cure. Nowadays, laparoscopic method is used for gastric cancer surgery, which provides an alternative to open technique. The successful application of the laparoscopic distal gastrectomy with D2 dissection for gastric cancer requires adequate understanding of the variations of gastric vascular anatomy as well as the anatomic characteristics. In this report, we present our laparoscopic subtotal gastrectomy with D2 lymph node dissection and jejunal Roux-en-Y reconstruction technique in a patient with aberrant left hepatic artery.

___

  • 1. Kitano S, Iso Y, Moriyama M, Sugimachi K. Laparoscopy-assisted Billroth I gastrectomy. Surg Laparosc Endosc 1994; 4: 146-8.
  • 2. Han HS, Kim YW, Yi NJ, Fleischer GD. Laparoscopy-assisted D2 subtotal gastrectomy in early gastric cancer. Surg Laparosc Endosc Percutan Tech 2003; 13: 361-5.
  • 3. Lee JH, Han HS, Lee JH. A prospective randomized study comparing open vs laparoscopy-assisted distal gastrectomy in early gastric cancer: early results. Surg Endosc 2005; 19: 168-73.
  • 4. Lee JH, Yom CK, Han HS. Comparison of long-term outcomes of laparoscopy-assisted and open distal gastrectomy for early gastric cancer. Surg Endosc 2009, 23: 1759-63.
  • 5. Japanese Gastric Cancer Association. Japanese classification of gastric carcinoma: 3rd English edition. Gastric Cancer 2011; 14: 101-12.
  • 6. Japanese Gastric Cancer Association. Japanese gastric cancer treatment guidelines 2010 (ver. 3). Gastric Cancer 2011; 14: 113- 23.
  • 7. Goh P, Tekant Y, Kum CK, Isaac J, Shang NS. Totally intra-abdominal laparoscopic Billroth II gastrectomy. Surg Endosc 1992; 6: 160.
  • 8. Goh P, Tekant Y, Isaac J, Kum CK, Ngoi SS. The technique of laparoscopic Billroth II gastrectomy. Surg Laparosc Endosc 1992; 2: 258-60.
  • 9. Adachi Y, Suematsu T, Shiraishi N, Katsuta T, Morimoto A, Kitano S, et al. Quality of life after laparoscopy-assisted Billroth I gastrectomy. Ann Surg 1999; 229: 49-54.
  • 10. Reyes CD, Weber KJ, Gagner M, Divino CM. Laparoscopic vs open gastrectomy. A retrospective review. Surg Endosc 2001; 15: 928- 31.
  • 11. Goh PM, Alponat A, Mak K, Kum CK. Early international results of laparoscopic gastrectomies. Surg Endosc 1997; 11: 650-2.
  • 12. Watson DI, Devitt PG, Game PA. Laparoscopic Billroth II gastrectomy for early gastric cancer. Br J Surg 1995; 82: 661-2.
  • 13. Kitano S, Shimoda K, Miyahara M, Shiraishi N, Bandoh T, Yoshida T, et al. Laparoscopic approaches in the management of patients with early gastric carcinomas. Surg Laparosc Endosc 1995; 5: 359-62.
  • 14. Nagai Y, Tanimura H, Takifuji K, Kashiwagi H, Yamoto H, Nakatani Y. Laparoscope-assisted Billroth I gastrectomy. Surg Laparosc Endosc 1995; 5: 281-7.
  • 15. Ballesta-Lopez C, Bastida-Vila X, Catarci M, Mato R, Ruggiero R. Laparoscopic Billroth II distal subtotal gastrectomy with gastric stump suspension for gastric malignancies. Am J Surg 1996; 171: 289-92.
  • 16. Seshadri PA, Mamazza J, Poulin EC, Schlachta CM. Technique for laparoscopic gastric surgery. Surg Laparosc Endosc Percutan Tech 1999; 9: 248-52.
  • 17. Hüscher CGS, Napolitano C, Chiodini S, et al. Gastrectomie totale coelio-assistee pour cancer. Le Journal de Coelio-chir 1997; 21: 41-4.
  • 18. Azagra JS, Goergen M, De Simone P, Ibanez-Aguirre J. Minimally invasive surgery for gastric cancer. Surg Endosc 1999; 13: 351-7.
  • 19. Goh PM, Khan AZ, So JB, Lomanto D, Cheah WK, Muthiah R, et al. Early experience with laparoscopic radical gastrectomy for advanced gastric cancer. Surg Laparosc Endosc Percutan Tech 2001; 11: 83-7.
  • 20. Lee WJ, Wang W, Chen TC, Chen JC, Ser KH. Totally laparoscopic radical BII gastrectomy for the treatment of gastric cancer: a comparison with open surgery. Surg Laparosc Endosc Percutan Tech 2008; 18: 369-74.
  • 21. Kanaya S, Gomi T, Momoi H, Tamaki N, Isobe H, Katayama T, et al. Delta-shaped anastomosis in totally laparoscopic Billroth I gastrectomy: new technique of intraabdominal gastroduodenostomy. J Am Coll Surg 2002; 195: 284-7.
  • 22. Kim JJ, Song KY, Chin HM, Kim W, Jeon HM, Park CH, et al. Totally laparoscopic gastrectomy with various types of intracorporeal anastomosis using laparoscopic linear staplers: preliminary experience. Surg Endosc 2008; 22: 436-42.
  • 23. Michels NA. Blood supply and anatomy of the upper abdominal organs with a descriptive atlas. Philadelphia: JB Lippincott; 1955. p. 248-72.
  • 24. Koops A, Wojciechowski B, Broering DC, Adam G, KrupskiBerdien G. Anatomic variations of the hepatic arteries in 604 selective celiac and superior mesenteric angiographies. Surg Radiol Anat 2004; 26: 239-44.
  • 25. Sakamoto Y, Takayama T, Nakatsuka T, Asato H, Sugawara Y, Sano K, et al. Advantage in using living donors with aberrant hepatic artery for partial liver graft arterialization. Transplantation 2002; 74: 518-21.
  • 26. Okano S, Sawai K, Taniguchi H, Takahashi T. Aberrant left hepatic artery arising from the left gastric artery and liver function after radical gastrectomy for gastric cancer. World J Surg 1993; 17: 70-3.
  • 27. Friesen SR. The significance of the anomalous origin of the left hepatic artery from the left gastric artery in operations upon the stomach and esophagus. Am Surg 1957; 23: 1103-8.
  • 28. Lurie AS. The significance of the variant left accessory hepatic artery in surgery for proximal gastric cancer. Arch Surg 1987; 122: 725-8.
  • 29. Hemming AW, Finley RJ, Evans KG, Nelems B, Fradet G. Esophagogastrectomy and the variant left hepatic artery. Ann Thorac Surg 1992; 54: 166-8.
  • 30. Lee SW, Shinohara H, Matsuki M, Okuda J, Nomura E, Mabuchi H, et al. Preoperative simulation of vascular anatomy by threedimensional computed tomography imaging in laparoscopic gastric cancer surgery. J Am Coll Surg 2003; 197: 927-36.
  • 31. Maruyama K, Gunvén P, Okabayashi K, Sasako M, Kinoshita T. Lymph node metastases of gastric cancer. General pattern in 1931 patients. Ann Surg 1989; 210: 596-602.
  • 32. Sasako M, McCulloch P, Kinoshita T, Maruyama K. New method to evaluate the therapeutic value of lymph node dissection for gastric cancer. Br J Surg 1995; 82: 346-51.
  • 33. Shinohara T, Ohyama S, Muto T, Yanaga K, Yamaguchi T. The significance of the aberrant left hepatic artery arising from the left gastric artery at curative gastrectomy for gastric cancer. Eur J Surg Oncol 2007; 33: 967-71.