Preserving Left Aberrant Hepatic Artery During Gastrectomy for Cancer – Literature Review and Case Report

Introduction: Identifying left aberrant hepatic artery during gastrectomy for cancer is occasional. In case of replaced left hepatic artery, its ligation can lead to hepatic injury or ischemia, while preserving it can cause difficulties during lymphadenectomy. In literature there is no consensus regarding preserving replaced left hepatic artery during gastrectomy for cancer. A recent study, analysing adverse effects of ligating an aberrant left hepatic artery, shows in patients with over 5 times elevated transaminase levels, increase in hospital length and postoperative complications. On the other hand, there are studies that consider ligation of aberrant left hepatic artery safe, the only inconvenient being postoperative transient elevation of transminase levels, when ligated artery diameter is over 1.5 mm. Material and methods: We report the case of a 65 years old male, known with myocardial infarction, admitted for epigastric pain, nausea, vomiting, dysphagia for solids and important weight loss. Upper gastrointestinal endoscopy with biopsy and computed tomography showed esogastric tumoral mass, signet ring cell carcinoma, no metastases. Intraopertive, we found replaced left hepatic artery arising from left gastric artery, close to the celiac trunk, its diameter being approximately 1 cm. Total radical D2 gastrectomy with mechanical eso-jejunal Roux-en-Y anastomosis was performed. Postoperative evolution was favorable surgically, but the patient had SarsCov2 infection during hospitalization. The final pathology report showed 18 lymph nodes examined, 5 being with adenocarcinoma metastases. Conclusions: Preserving replaced left hepatic artery during gastrectomy for cancer is preferable, lymphadenectomy not being affected. Potential postoperative complications resulted from ligation of replaced left hepatic artery could have chanced the prognosis.