J.Jpn. Surg. Soc.. 118(1): 25-30, 2017

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Feature topic

CLINICAL UTILITY OF THREE-DIMENSIONAL ARTERIOGRAPHY IN ENDOSCOPIC SURGERY FOR UPPER GASTROINTESTINAL CANCER

Preoperative simulation of vascular anatomy has been widely accepted in order to reduce surgical complications and improve postoperative outcomes. In esophagectomy, preservation of the bronchial artery (BA) was shown to reduce postoperative pulmonary complications. However, some anomalous BA branching patterns have been reported and these can make BA preservation difficult during surgery. Recently, the clinical utility of preoperative three-dimensional computed tomography angiography (3D-CTA) has been reported as a form of preoperative anatomical simulation. Consequently, the BA was safely preserved and efficient lymph node (LN) dissection was achieved. In surgery for gastric cancer, tracing the inner dissectable layer is necessary for LN dissection. Particularly in laparoscopic total gastrectomy with spleen preservation, there is considerable variation in the vascular anatomy of the splenic artery, splenic vein, and short gastric artery. Therefore, preoperative 3D-CTA could improve the safety of this procedure. Recently, the number of dissected LNs has been shown to be increased after introduction of 3D-CTA in laparoscopic surgery for both esophageal and gastric cancer, which showed that preoperative anatomical simulation could achieve more radical LN dissection. As a future perspective, intraoperative navigation systems could become more practical guides for endoscopic surgery for upper gastrointestinal cancer.

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