Preoperative Evaluation Value of Multislice Spiral Computed Tomography Angiography for Normative Radical Gastrectomy_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

LIU Chao , HUANG Yuan , LIN Jinling.

Department of Gastroenterology Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China;

Corresponding author：

Keywords：

Multislice spiral computed tomography angiography; Radical gastrectomy; TNM stage

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ObjectiveTo explore the evaluation value of preoperative multislice spiral computed tomography angiography (MSCTA) for normative radical gastrectomy. MethodsThe anatomic distributions of celiac trunk and its three branches and their tributaries (common hepatic artery, right hepatic artery, left hepatic artery, splenic artery, and left gastric artery) of 86 patients with gastric cancer were comprehended by preoperative MSCTA, which were verified during the surgery. Simultaneously preoperative TNM staging was evaluated by MSCTA, which compared with postoperative pathological results. ResultsThe accuracy rate of preoperative MSCTA evaluating the distribution of celiac trunk and its three branches and their tributaries was 100%. Abnormal hepatic arteries were found in 22 cases by MSCTA, the mutation rate was 25.58%. Abnormal right hepatic arteries were found in 11 cases (12.79%), abnormal left hepatic arteries in 7 cases (8.14%), both abnormal right and left hepatic arteries in 1 case (1.16%), and abnormal common hepatic arteries in 3 cases (3.49%). Straight splenic arteries were found in 24 cases (27.91%), slightly curved splenic arteries in 44 cases (51.16%), and significantly curved splenic arteries in 18 cases (20.93%). Compared with postoperative pathological results, the accuracy rates of preoperative MSCTA evaluating gastric cancer T, N, and M staging were 75.58%（65/86）, 74.42%(64/86), and 91.86%(79/86), respectively. ConclusionsPreoperative MSCTA is an objective way to assess the distributions of celiac artery trunk and related tributaries of patients with gastric cancer. Also, it is an accurate method to evaluate the preoperative TNM stage of gastric cancer, which can help to make an individual operative plan and avoid the intraoperative injury of the artery.

Citation： LIU Chao,HUANG Yuan,LIN Jinling.. Preoperative Evaluation Value of Multislice Spiral Computed Tomography Angiography for Normative Radical Gastrectomy. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2011, 18(4): 441-445. doi: Copy

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1. Sun Z, Xu HM. Stage and microscopic positive margins in the treatment of patients with gastric cancer [J]. Ann Surg Oncol, 2010, 17(3): 943945.
2. Hiatt JR, Gabbay J, Busuttil RW. Surgical anatomy of the hepatic arteries in 1 000 cases [J]. Ann Surg, 1994, 220(1): 5052.
3. Michels MA. Blood supply and anatomy of the upper abdominal organs [J]. Proc R Soc Med, 1956, 49(9): 683.
4. Edge SB, Byrd DR, Compton CC, et al. AJCC cancer staging manual (7th ed) [M]. New York, NY: Springer, 2010: 113.
5. D’Elia F, Zingarelli A, Palli D, et al. Hydrodynamic CT preoperative staging of gastric cancer: correlation with pathological findings. A prospective study of 107 cases [J]. Eur Radiol, 2000, 10(12): 18771885.
6. Michels NA. Newer anatomy of the liver and its variant blood supply and collateral circulation [J]. Am J Surg, 1966, 112(3): 337347.
7. Chen CY, Lee RC, Tseng HS, et al. Normal and variant anatomy of hepatic arteries: angiographic experience [J]. Zhonghua Yi Xue Za Zhi (Taipei), 1998, 61(1): 1723.
8. Winter TC 3rd, Freeny PC, Nghiem HV, et al. Hepatic arterial anatomy in transplantation candidates: evaluation with threedimensional CT arteriography [J]. Radiology, 1995, 95(2): 363370.
9. Weszelits V, Doros A, Puhl M, et al. 3D CT angiography in patients before and after liver transplantation [J]. Transplant Proc, 2001, 33(12): 13721376.
10. Stemmler BJ, Paulson EK, Thornton FJ, et al. Dualphase 3D MDCT angiography for evaluation of the liver before hepatic resection [J]. AJR Am J Roentgenol, 2004, 183(6): 15511557.
11. 叶启发. 肝动脉变异与肝移植的关系 [J]. 中国现代手术学杂志, 2006, 10(6): 401403.
12. Laghi A, Catalano C, Iannaccone R, et al. Multislice spiral CT angiography in the evaluation of the anatomy of splanchnic vessels: preliminary experience [J]. Radiol Med, 2001, 102(3): 127131.
13. Chang L, Babineau TJ. Simulation training for surgical residents: cool computers or core curriculum? [J]. Curr Surg, 2006, 63(1): 48.
14. Napieralski R, Ott K, Kremer M, et al. Methylation of tumorrelated genes in neoadjuvanttreated gastric cancer: relation to therapy response and clinicopathologic and molecular features [J]. Clin Cancer Res, 2007, 13(17): 50955102.
15. Roth AD, Fazio N, Stupp R, et al. Docetaxel, cisplatin, and fluorouracil; docetaxel and cisplatin; and epirubicin, cisplatin, and fluorouracil as systemic treatment for advanced gastric carcinoma: a randomized phase Ⅱ trial of the Swiss Group for Clinical Cancer Research [J]. J Clin Oncol, 2007, 5(22): 32173223.
16. Lee IJ, Lee JM, Kim SH, et al. Helical CT evaluation of the preoperative staging of gastric cancer in the remnant stomach [J]. AJR Am J Roentgenol, 2009, 192(4): 902908.
17. Kim AY, Kim HJ, Ha HK. Gastric cancer by multidetector row CT: preoperative staging [J]. Abdom Imaging, 2005, 30(4): 465472.
18. Kwee RM, Kwee TC. Imaging in local staging of gastric cancer: a systematic review [J]. J Clin Oncol, 2007, 25(15): 21072116.
19. 黄子星, 陈心足, 宋彬, 等. 64排螺旋CT对Ⅳ期胃癌术前分期的价值 [J]. 中国普外基础与临床杂志, 2008, 15(8): 623627.
20. 曲宁, 罗娅红. 多层螺旋CT在胃癌TNM分期中的诊断价值 [J]. 实用肿瘤学杂志, 2007, 21(6): 551554.
21. 高剑波, 郭华, 杨学华, 等. 胃癌TNM分期螺旋CT与病理学的对照研究 [J]. 腹部影像学, 2006, 21(11): 11551158.
22. Wei WZ, Yu JP, Li J, et al. Evaluation of contrastenhanced helical hydroCT in staging gastric cancer [J]. World J Gastroenterol, 2005, 11(29): 45924595.
23. Bhandari S, Shim CS, Kim JH, et al. Usefulness of threedimensional, multidetector row CT (virtual gastroscopy and multiplanar reconstruction) in the evaluation of gastric cancer: a comparison with conventional endoscopy, EUS, and histopathology [J]. Gastrointest Endosc, 2004, 59(6): 619626.
24. Habermann CR, Weiss F, Riecken R, et al. Preoperative staging of gastric adenocarcinoma: comparison of helical CT and endoscopic US [J]. Radiology, 2004, 230(2): 465471.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Preoperative Evaluation Value of Multislice Spiral Computed Tomography Angiography for Normative Radical Gastrectomy

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