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

Abstract

AbstractIn 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.