The Impact of Vascular Anatomic Variations in the Infra-Pyloric Area on the Surgical Outcomes of Laparoscopic Pylorus-Preserving Gastrectomy in Early Gastric Cancer: A Post Hoc Analysis of a Multicenter Prospective Trial (KLASS-04)
Year: 2025
Type: article
Abstract: Background/Objectives: During laparoscopic pylorus-preserving gastrectomy (LPPG), the preservation of the infra-pyloric artery (IPA) and dissection of the infra-pyloric lymph node (LN) station 6 are essential, underscoring the importance of understanding the anatomical structure of the IPA. This study aimed to investigate anatomical variations in the IPA and surgical outcomes based on data from a multicenter prospective trial. Methods: A post hoc analysis was conducted based on the Korean Laparoendoscopic Gastrointestinal Surgery Study (KLASS)-04 trial, in which patients randomly underwent LPPG or laparoscopic distal gastrectomy (LDG). The IPA variations were categorized into three groups: distal, caudal, and proximal. Clinicopathological characteristics and surgical outcomes were analyzed according to the IPA type. Results: Among the 192 patients, the distribution of IPA types was as follows: 45 (23.44%) distal, 74 (38.54%) caudal, and 73 (38.02%) proximal. There were no significant differences in the clinicopathological characteristics between the IPA types. Of the 119 patients who underwent LPPG, a significant difference in operative time was observed based on the IPA type, with a longer duration observed with the distal type compared to that of the proximal type (distal type vs. proximal type: 202.5 (150–275) vs. 170 (105–265) min, p = 0.0300). No significant differences were observed in other surgical outcomes. Conclusions: The distribution of IPA types was more diverse than that reported in previous studies. There was a statistically significant difference in the operating time based on the IPA type. Identifying IPA variations during LPPG may be beneficial for gastric cancer surgeons.
Source: Journal of Clinical Medicine
DOI: 10.3390/jcm14072508
Institutions: Inje University, Inje University Ilsan Paik Hospital, Catholic University of Korea, National Cancer Center, Seoul National University Hospital, Seoul National University, Seoul National University Bundang Hospital, Gyeongsang National University Hospital, Ajou University Hospital, Yonsei University, Severance Hospital, Yonsei University Health System, Kyungpook National University Hospital, The Catholic University of Korea Yeouido St. Mary's Hospital, Chonnam National University, Chonnam National University Hwasun Hospital
Language: English
Subfield: Pulmonary and Respiratory Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $3,137
OpenAlex ID: W4409215133