Pre-operative angiography in gastric cancer surgery with extended lymphadenectomy

BACKGROUND/AIMS: The value of pre-operative angiographic evaluation in pati ents undergoing gastric cancer surgery with extended lymphadenectomy was as sessed in a prospective study comparing exposed and unexposed groups of pat ients. METHODOLOGY: During the period from July 1991 to October 1997, 76 patients (Group A-exposed) were pre-operatively submitted to a digital subtraction a ngiography (DSA) after informed consent, Concurrently, 94 patients (Group B -unexposed) were included as an unexposed reference group, All patients und erwent total or subtotal gastrectomy with D-2 lymphadenectomy according to the guidelines proposed by the Japanese Research Society for Gastric Cancer (JRSGC). RESULTS: In 34 (45%) exposed patients (Group A), DSA detected an atypical v ascular anatomy, Major anatomical variations of the celiac axis, its branch es and the superior mesenteric artery were discovered in 4 subjects (5%), V ascular anomalies affecting the surgical tactics of lymphadenectomy were de tected in less than 8% of patients, Five post-operative deaths (6.6%) were registered between patients of the Group A, exposed to pre-operative angiog raphy, 8 in the unexposed Group B (8,5%), Post-operative morbidity was sign ificantly higher (P=0.038) in the Group B (34%) in comparison to Group A (2 0%) but no difference in risk of individual complications was detected. CONCLUSIONS: Although useful in the presence of major vascular anomalies, i t appears that preoperative angiography did not significantly reduce intra- and post-operative complications associated with radical gastrectomy combi ned with extended lymphadenectomy. Arteriography is therefore not routinely recommendable but its use is mandatory in specific operations for gastric cancer.