Pre-operative angiography in gastric cancer surgery with extended lymphadenectomy

BACKGROUND/AIMS: The value of pre-operative angiographic evaluation in patients undergoing gastric cancer surgery with extended lymphadenectomy was assessed in a prospective study comparing exposed and unexposed groups of patients. METHODOLOGY: During the period from July 1991 to October 1997, 76 patients (Group A-exposed) were pre-operatively submitted to a digital subtraction angiography (DSA) after informed consent, Concurrently, 94 patients (Group B-unexposed) were included as an unexposed reference group, All patients underwent 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 vascular anatomy, Major anatomical variations of the celiac axis, its branches and the superior mesenteric artery were discovered in 4 subjects (5%), Vascular anomalies affecting the surgical tactics of lymphadenectomy were detected in less than 8% of patients, Five post-operative deaths (6.6%) were registered between patients of the Group A, exposed to pre-operative angiography, 8 in the unexposed Group B (8,5%), Post-operative morbidity was significantly higher (P=0.038) in the Group B (34%) in comparison to Group A (20%) but no difference in risk of individual complications was detected. CONCLUSIONS: Although useful in the presence of major vascular anomalies, it appears that preoperative angiography did not significantly reduce intra- and post-operative complications associated with radical gastrectomy combined with extended lymphadenectomy. Arteriography is therefore not routinely recommendable but its use is mandatory in specific operations for gastric cancer.