Robotic distal gastrectomy with D2 lymphadenectomy for advanced gastric cancer with celiac-arterial anomaly (Adachi type VI, group 26): Case report.

In gastric cancer surgery, some celiac-arterial anomalies are associated with a risk of anatomical misidentification and insufficient lymphadenectomy. We herein report a case of successful robotic distal gastrectomy with D2 lymphadenectomy based on preoperative, anatomical recognition using three-dimensional computed tomography (3D-CT) in a patient with advanced gastric cancer and a rare anomaly of the celiac artery. A 64-year-old, male patient was referred to our division with a diagnosis of advanced gastric cancer. The 3D-CT angiography demonstrated an Adachi type VI, group 26 celiac-arterial anomaly, in which the common hepatic artery branched from the left gastric artery but was widely dislocated from the supra-pancreatic region. Moreover, the left gastric artery branched three gastric branches, although the right gastric artery was absent. Robotic surgery enabled the safe and precise gastrectomy and lymphadenectomy.
(© 2023 Asia Endosurgery Task Force and Japan Society of Endoscopic Surgery and John Wiley & Sons Australia, Ltd.)