The Hidden Challenge: Hepatic Artery Variations and Their Impact on Laparoscopic Gastric Cancer Surgery Outcomes

Introduction: Few studies have evaluated the relationship between vascular anatomical variations and laparoscopic gastrectomy outcomes in patients with gastric cancer. In this study, we aimed to evaluate the effects of preoperatively detected hepatic artery variations on surgical outcomes in patients with gastric cancer undergoing laparoscopic radical gastrectomy. Materials and Methods: A retrospective analysis was conducted on the radiological, intraoperative, postoperative, and clinical data of 186 patients who underwent laparoscopic gastrectomy for gastric cancer. Patients were divided into two groups: those with variations and those without. The distinction between the two groups was determined by preoperative radiological imaging. The impact of these variations on perioperative and postoperative complications, as well as surgical outcomes, was subsequently evaluated. Results: Arterial variations were identified in 69 patients (37.1%). The most prevalent arterial variation was the aberrant left hepatic artery, observed in 25 patients (13.4%). In the cohort exhibiting arterial variations, operation time (P < .001; 203 minutes [195-220] versus 191 minutes [180-202]), intraoperative blood loss (P < .001; 100 mL [70-150] versus 50 mL [40-80]), and the total number of dissected lymph nodes (P = .006; 24 [20-34] versus 21 [17-29]) were found to be significantly higher, with statistically significant differences observed between the groups. Conclusions: A comprehensive evaluation of radiological imaging in patients prior to laparoscopic gastric cancer surgery, employing a multidisciplinary approach and preoperative identification of potential variations, has the potential to prevent complications and enhance surgical outcomes.