Clinical significance of celiac truncus variations in gastric cancer surgery: a retrospective cohort study in the Turkish population

Abstract

Aims: Gastric cancer is the fifth most common malignancy worldwide. Celiac truncus variations are one of the most important factors complicating the surgical process of total gastrectomy and D2 lymph node dissection in the surgical treatment of gastric cancer. This study aimed to evaluate the frequency of celiac truncus variations in patients undergoing gastrectomy for gastric cancer and their impact on clinical outcomes. Methods: Preoperative computed tomography images of 114 patients who underwent total gastrectomy between January 2023 and June 2025 were retrospectively evaluated. Arterial variations were categorized according to the Michels classification. Postoperative liver enzyme levels, lymph node dissection efficacy, and clinical outcomes were analyzed in patients with arterial anatomic variations. Results: Celiac truncus variations were detected in 19.3% of patients (n=22). The most common variation was ALHA (aberran left hepatic artery), at a rate of 9.6%. No statistically significant difference was found between postoperative 24-hour ALT and AST levels in patients with hepatic artery variations and those with normal anatomy. The increase in AST and ALT parameters at the 24th hour postoperatively in 22 patients with hepatic artery variations was not significant compared to the preoperative results (AST=22-26.5, p=0.476 and ALT=18-18.5, p=0.602). There was no significant difference between the groups in terms of lymph node dissection efficacy (22.8±7.7 vs 23.3±11.6, p=0.985) and oncological outcomes. Conclusion: Celiac artery variations, especially those in the presence of ALHA, can be safely managed with appropriate perioperative assessment and experienced surgical technique. While these variations do not negatively affect oncological surgical outcomes, transient postoperative liver enzyme elevations may occur.

Keywords

• Gastric cancer
• celiac truncus variation
• D2 lymph node dissection
• Michels classification

Çölyak trunkus varyasyonlarının mide kanseri cerrahisindeki klinik önemi: Türk popülasyonunda retrospektif kohort çalışması

Abstract

Amaç: Dünya genelinde en sık görülen beşinci malignite olan mide kanserinin cerrahi tedavisinde total gastrektomi ve D2 lenf nodu diseksiyonunun cerrahi sürecinin zorlaştıran en önemli faktörlerden biri çölyak trunkus varyasyonlarıdır. Bu çalışmada, mide kanseri nedeniyle gastrektomi yapılan hastalarda çölyak trunkus varyasyonlarının sıklığı ve klinik sonuçlara etkilerinin değerlendirilmesi amaçlanmıştır. Yöntem: Ocak 2023 - Haziran 2025 yılları arasında total gastrektomi uygulanan 114 hastanın preoperatif bilgisayarlı tomografi görüntüleri retrospektif olarak değerlendirildi. Michels sınıflandırmasına göre arteriyel varyasyonlar kategorize edildi. Arteriel anatomik varyasyona sahip olgularda postoperatif karaciğer enzim düzeyleri, lenf nodu diseksiyon etkinliği ve klinik sonuçlar analiz edildi. Bulgular: Hastaların %19,3'ünde (n=22) çölyak trunkus varyasyonu saptandı. En sık varyasyon %9,6 oranıyla ALHA idi. Hepatik arter varyasyonu bulunan hastalar ile normal anatomili hastaların postoperatif 24.saat ALT ve AST düzeyleri arasında istatistiksel anlamlı fark bulunmadı. Hepatik arter varyasyonu olan 22 hastanın postoperatif 24.saat AST ve ALT parametrelerindeki artış preoperatif dönem sonuçlarına göre anlamlı değildir (AST= 22 ve 26,5 p=0,476, ALT= 18 ve 18,5 p=0,602). Lenf nodu diseksiyonu etkinliği (22,8 ± 7,7 vs 23,3 ± 11,6, p=0,985) ve onkolojik sonuçlar açısından gruplar arasında anlamlı fark saptanmadı. Sonuç: Çölyak arter varyasyonları, özellikle ALHA varlığı, uygun peroperatif değerlendirme ve deneyimli cerrahi teknikle güvenle yönetilebilmektedir. Bu varyasyonlar onkolojik cerrahi sonuçları olumsuz etkilemezken, postoperatif geçici karaciğer enzim yükselmeleri görülebilmektedir.

Keywords

• Mide kanseri
• Çölyak trunkus varyasyon
• D2 lenf nodu diseksiyonu
• Michels sınıflaması

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