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. 2025 Apr 7;14(7):2508.
doi: 10.3390/jcm14072508.

The Impact of Vascular Anatomic Variations in the Infra-Pyloric Area on the Surgical Outcomes of Laparoscopic Pylorus-Preserving Gastrectomy in Early Gastric Cancer: A Post Hoc Analysis of a Multicenter Prospective Trial (KLASS-04)

Sang Soo Eom  1 , Sin Hye Park  2 , Young Shick Rhee  3 , Sa-Hong Kim  4 , Hyuk-Joon Lee  5   6 , Young-Woo Kim  3 , Han-Kwang Yang  5   6 , Do Joong Park  5   6   7 , Sang Uk Han  8 , Hyung-Ho Kim  7 , Woo Jin Hyung  9 , Ji-Ho Park  10 , Yun-Suhk Suh  5   6   7 , Oh-Kyung Kwon  11 , Wook Kim  12 , Young-Kyu Park  13 , Hong Man Yoon  3 , Sang-Hoon Ahn  7 , Seong-Ho Kong  5   6 , Keun Won Ryu  3
Affiliations

The Impact of Vascular Anatomic Variations in the Infra-Pyloric Area on the Surgical Outcomes of Laparoscopic Pylorus-Preserving Gastrectomy in Early Gastric Cancer: A Post Hoc Analysis of a Multicenter Prospective Trial (KLASS-04)

Sang Soo Eom et al. J Clin Med. .

Abstract

Background/Objectives: During laparoscopic pylorus-preserving gastrectomy (LPPG), the preservation of the infra-pyloric artery (IPA) and dissection of the infra-pyloric lymph node (LN) station 6 are essential, underscoring the importance of understanding the anatomical structure of the IPA. This study aimed to investigate anatomical variations in the IPA and surgical outcomes based on data from a multicenter prospective trial. Methods: A post hoc analysis was conducted based on the Korean Laparoendoscopic Gastrointestinal Surgery Study (KLASS)-04 trial, in which patients randomly underwent LPPG or laparoscopic distal gastrectomy (LDG). The IPA variations were categorized into three groups: distal, caudal, and proximal. Clinicopathological characteristics and surgical outcomes were analyzed according to the IPA type. Results: Among the 192 patients, the distribution of IPA types was as follows: 45 (23.44%) distal, 74 (38.54%) caudal, and 73 (38.02%) proximal. There were no significant differences in the clinicopathological characteristics between the IPA types. Of the 119 patients who underwent LPPG, a significant difference in operative time was observed based on the IPA type, with a longer duration observed with the distal type compared to that of the proximal type (distal type vs. proximal type: 202.5 (150-275) vs. 170 (105-265) min, p = 0.0300). No significant differences were observed in other surgical outcomes. Conclusions: The distribution of IPA types was more diverse than that reported in previous studies. There was a statistically significant difference in the operating time based on the IPA type. Identifying IPA variations during LPPG may be beneficial for gastric cancer surgeons.

Keywords: gastrectomy; gastric cancer; pylorus.

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Conflict of interest statement

The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Variation in infra-pyloric artery (IPA). (A) Distal type, originating from the anterior superior pancreaticoduodenal artery (ASPDA). (B) Caudal type, originating from the right gastroepiploic artery (RGEA). (C) Proximal type, originating from the gastroduodenal artery (GDA).
Figure 2
Figure 2
CONSORT diagram.
See this image and copyright information in PMC

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