Anatomical variation of infra-pyloric artery origination： A prospective multicenter observational study (IPA-Origin)  

作　　者：Rulin Miao Jianjun Qu Zhengrong Li Daguang Wang Jiang Yu Weidong Zang Yong Li Fenglin Liu Jian Zhang Wu Song Kai Ye Su Yan Wei Wang Shuangyi Ren Lu Zang Changqing Jing Li Zhang Kuan Wang Weihua Fu Lin Fan Bin Liang Gang Zhao Jun Cai Li Yang Jiaming Zhu Jun You Kun Yang Qingxing Huang Zhaojian Niu Ning Ning Xingfeng Qiu Gang Ji Feng Liang Hua Huang Chao Gao Fei Shan Shuangxi Li Yongning Jia Lianhai Zhang Xiangji Ying Yan Zhang Zhaode Bu Xiangqian Su Gang Zhao Ziyu Li Jiafu Ji 

机构地区：[1]Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Gastrointestinal Cancer Center, Peking University Cancer Hospital & Institute, Beijing 100142, China [2]Department of Surgical Oncology, Weifang People's Hospital, Weifang 261000, China [3]Department of General Surgery, the First Affiliated Hospital of Nanchang University, Nanchang 330006, China [4]Department of Gastrointestinal Surgery, the First Hospital of Jilin University, Changehun 130021, China [5]Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China [6]Department of Gastrointestinal Cancer Surgery, Fujian Provincial Cancer Hospital, Fuzhou 350014, China [7]Department of General Surgery, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China [8]Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China [9]Department of Gastrointestinal Surgery, Hangzhou First People's Hospital, Hangzhou 310006, China [10]Department of Gastrointestinal Surgery, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China [11]Department of Surgical Oncology, the Second Affiliated Hospital of Fujian Medical University, Quanzhou 362000, China [12]Department of Surgical Oncology, Affiliated Hospital of Qinghai University, Xining 810001, China [13]Department of Gastrointestinal Surgery, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou 510120, China [14]Department of General Surgery, the Second Hospital of Dalian Medical University, Dalian 116023, China [15]Department of General Surgery, Shanghai Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, China [16]Department of Gastrointestinal Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan 250021, China [17]Department of Gastrointestinal Surgery, Harbin Medical University Cancer Hospital, Harbin 150081, China [18]Department of General Surgery, Tianjin Medical University General Hospital

出　　处：《Chinese Journal of Cancer Research》2018年第5期500-507,共8页中国癌症研究（英文版）

基　　金：funded by the Gastric Cancer Diagnose and Treatment Project(D171100006517004,D17110700650000)of Beijing Municipal Science&Technology Commission;supported by Beijing Municipal Administration of Hospital Clinical Medicine Development of Special Funding Support(ZYLX201701)

摘　　要：Objective： Infra-pyloric artery （IPA） is an important anatomical landmark in treatment of gastric cancer and is the key vessel for pylorus-preserving gastrectomy and subgroup of infra-pyloric lymph nodes. However, its anatomical variation is not thoroughly understood. Our study aimed to clarify the origination of the IPA. Methods： We did this prospective, multicenter, open-label, observational study at gastric surgery departments of 34 hospitals in China. Gastric cancer patients aged 18 years or older and scheduled to undergo elective total or distal gastrectomy were assigned. During the surgery, IPA dissecting and exposing the origination point with photographs or video clips were required. The primary outcome was the origination of the IPA. Analysis of variance, χ2 tests and Fisher＇s tests were used to analyze the differences between groups. The study is registered at Clinicaltrials.gov （No. NCT03071237）. Results： Between May 8 and July 31, 2017, 429 patients were assigned for the study, and 419 （97.7%） patients had the IPA dissected and recorded through photograph or video and were included in the primary outcome analysis. The median age was 62 years old, and 73.7% were male. Among the patients, 78.5% received laparoscopic surgery. Single IPA origination was identified in 398 （95.0%） patients, including gastroduodenal artery （GDA） in 154 （36.8%） patients, anterior superior pancreaticoduodenal artery （ASPDA） in 130 （31.0%） patients, and right gastroepiploic artery （RGEA） in 114 （27.2%） patients. Fifteen （3.6%） patients were identified with multiple IPA and 6 （1.4%） patients were identified as IPA absence. The differences in the distribution of surgical approach （P=0.003） and geographic area （P=0.030） were statistically significant. No difference was shown in sex, age, gastrectomy type, tumor location, and clinical T, N and M stage. Conclusions： Our study found that the IPA originates from GDA, ASPDA and RGEA in similar proportions. Laparoscopic Objective： Infra-pyloric artery （IPA） is an important anatomical landmark in treatment of gastric cancer and is the key vessel for pylorus-preserving gastrectomy and subgroup of infra-pyloric lymph nodes. However, its anatomical variation is not thoroughly understood. Our study aimed to clarify the origination of the IPA. Methods： We did this prospective, multicenter, open-label, observational study at gastric surgery departments of 34 hospitals in China. Gastric cancer patients aged 18 years or older and scheduled to undergo elective total or distal gastrectomy were assigned. During the surgery, IPA dissecting and exposing the origination point with photographs or video clips were required. The primary outcome was the origination of the IPA. Analysis of variance, χ2 tests and Fisher＇s tests were used to analyze the differences between groups. The study is registered at Clinicaltrials.gov （No. NCT03071237）. Results： Between May 8 and July 31, 2017, 429 patients were assigned for the study, and 419 （97.7%） patients had the IPA dissected and recorded through photograph or video and were included in the primary outcome analysis. The median age was 62 years old, and 73.7% were male. Among the patients, 78.5% received laparoscopic surgery. Single IPA origination was identified in 398 （95.0%） patients, including gastroduodenal artery （GDA） in 154 （36.8%） patients, anterior superior pancreaticoduodenal artery （ASPDA） in 130 （31.0%） patients, and right gastroepiploic artery （RGEA） in 114 （27.2%） patients. Fifteen （3.6%） patients were identified with multiple IPA and 6 （1.4%） patients were identified as IPA absence. The differences in the distribution of surgical approach （P=0.003） and geographic area （P=0.030） were statistically significant. No difference was shown in sex, age, gastrectomy type, tumor location, and clinical T, N and M stage. Conclusions： Our study found that the IPA originates from GDA, ASPDA and RGEA in similar proportions. Laparoscopic

关 键 词：Infra-pyloric artery ORIGINATION ANATOMY gastric cancer 

分 类 号：R735.2[医药卫生—肿瘤]