A patient with superior mesenteric artery lymph node metastasis after laparoscopic gastrectomy for gastric cancer with Adachi type VI vascular anomaly: A case report

• Published in: International journal of surgery case reports Vol. 77; pp. 743 - 747
• Main Authors: Hirai, Kenjiro, Aoyama, Taro, Hirata, Wataru, Okabe, Hiroshi, Mitsuyoshi, Akira
• Format: Report
• Language: English
• Published: 01.01.2020
• ISSN: 2210-2612; 2210-2612
• DOI: 10.1016/j.ijscr.2020.11.086

INTRODUCTIONDue to recent advances in surgical procedures and instruments, laparoscopic gastrectomy for gastric cancer has been widely performed, and previous studies reported laparoscopic surgery for gastric cancer with Adachi type VI vascular anomaly. In Adachi type VI patients, the common hepatic artery (CHA) originates from the superior mesenteric artery (SMA); therefore, the route of lymph flow differs from the normal route, and the supra- and infrapyloric lymph nodes (LN) may reach SMA LN. However, metastasis has not yet been reported. A case of SMA LN metastasis 3 years after laparoscopic distal gastrectomy for gastric cancer with Adachi type VI CHA anomaly, which was diagnosed using preoperative computed tomography (CT), was described herein. PRESENTATION OF CASEThe patient was a 77-year-old male. Laparoscopic distal gastrectomy and D2 + 14v LN dissection for gastric cancer with Adachi type VI vascular anomaly were performed. Three years after surgery, periodic CT revealed swelling of regional and mediastinal SMA LN, leading to a diagnosis of recurrent gastric cancer. A histopathological examination of the resected specimen showed metastases to the greater curvature right group and infrapyloric LN. DISCUSSIONMetastasis to LN No. 6 may have reached SMA LN via the gastroduodenal artery and CHA, but not the celiac artery. CONCLUSIONIf preoperative diagnostic imaging suggests metastasis to the greater curvature right group and pyloric regions in gastric cancer patients with Adachi type VI vascular anomaly, LN dissection along CHA originating from SMA and the hepatomesenteric trunk needs to be considered.