Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2019 Jun;33(6):1903-1909.
doi: 10.1007/s00464-018-6470-z. Epub 2018 Sep 26.

Anatomic variations in the left gastric vein and their clinical significance during laparoscopic gastrectomy

Hayemin Lee  1 , Junhyun Lee  2
Affiliations

Anatomic variations in the left gastric vein and their clinical significance during laparoscopic gastrectomy

Hayemin Lee et al. Surg Endosc. 2019 Jun.

Abstract

Background: Surgeons normally encounter the left gastric vein (LGV) during laparoscopic gastrectomy (LG) for gastric cancer, and the various anatomic variants of this vessel make the procedure difficult. The objective of this study was to classify anatomic variants of the LGV in the laparoscopic operation field and clarify their clinical significance during LG.

Methods: In total, 405 patients who underwent LG in 2013-2017 for gastric cancer were enrolled in the study. LGV drainage was classified into six types by the anatomic relation of the LGV to the arteries of the celiac axis: Type Ia [LGV runs anteriorly to the common hepatic artery (CHA)], Type Ip (LGV runs posteriorly to CHA), Type II (LGV runs anteriorly to the left gastric artery), Type IIIa [LGV runs anteriorly to the splenic artery (SA)], Type IIIp (LGV runs posteriorly to SA), and Type IV (LGV runs cranially into the proximal portal vein or liver parenchyma). If the LGV was injured during the operation, the patient was included as a member of the injury group (IG).

Results: Most patients (n = 391, 96.5%) had a single LGV, whereas 14 (3.5%) patients had double LGVs. Type Ip was the most common of the six drainage types (n = 195, 48.1%). The number of patients in the IG was 49 (13.0%). Types I and III were relatively easily injured when compared with type II (p = 0.025). Patients in the IG had longer operation times, more blood loss, and more lymph node metastases than the non-IG patients.

Conclusions: In most patients, the LGV drains posteriorly to the CHA or anteriorly to the LGA. Gastric surgeons should take great care not to injure the LGV during LG when it is not present on the anterior side of the celiac axis.

Keywords: Anatomic variants; Laparoscopic gastrectomy; Left gastric vein.

PubMed Disclaimer

References

    1. Douglass BE, Baggentoss AH, Hollinshead WH (1950) The anatomy of the portal vein and its tributaries. Surg Gynecol Obstet 91:562–576 - PubMed
    1. Natsume T, Shuto K, Yanagawa N, Akai T, Kawahira H, Hayashi H, Matsubara H (2011) The classification of anatomic variations in the perigastric vessels by dual-phase CT to reduce intraoperative bleeding during laparoscopic gastrectomy. Surg Endosc 25:1420–1424 - DOI
    1. Yuasa Y, Okitsu H, Goto M, Kuramoto S, Tomibayashi A, Matsumoto D, Edagawa H, Mori O, Tani R, Akagawa T, Kinoshita M, Akagawa Y, Tani H, Ohnishi N, Shirono R (2016) Three-dimensional CT for preoperative detection of the left gastric artery and left gastric vein in laparoscopy-assisted distal gastrectomy. Asian J Endosc Surg 9:179–185 - DOI - PubMed
    1. Kim HH, Hyung WJ, Cho GS, Kim MC, Han SU, Kim W, Ryu SW, Lee HJ, Song KY (2010) Morbidity and mortality of laparoscopic gastrectomy versus open gastrectomy for gastric cancer: an interim report—a phase III multicenter, prospective, randomized trial (KLASS trial). Ann Surg 251:417–420 - DOI - PubMed
    1. Kim HH, Han SU, Kim MC, Hyung WJ, Kim W, Lee HJ, Ryu SW, Cho GS, Song KY, Ryu SY (2014) Long-term results of laparoscopic gastrectomy for gastric cancer: a large-scale case-control and case-matched korean multicenter study. J Clin Oncol 32:627–633 - DOI - PubMed

LinkOut - more resources