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

ABSTRACT: 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, ?2 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 surgery may be more helpful in dissection of the IPA than open surgery.

SUBMITTER: Miao R

PROVIDER: S-EPMC6232364 | biostudies-literature | 2018 Oct

REPOSITORIES: biostudies-literature

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

Miao Rulin R Qu Jianjun J Li Zhengrong Z Wang Daguang D Yu Jiang J Zang Weidong W Li Yong Y Liu Fenglin F Zhang Jian J Song Wu W Ye Kai K Yan Su S Wang Wei W Ren Shuangyi S Zang Lu L Jing Changqing C Zhang Li L Wang Kuan K Fu Weihua W Fan Lin L Liang Bin B Zhao Gang G Cai Jun J Yang Li L Zhu Jiaming J You Jun J Yang Kun K Huang Qingxing Q Niu Zhaojian Z Ning Ning N Qiu Xingfeng X Ji Gang G Liang Feng F Huang Hua H Gao Chao C Shan Fei F Li Shuangxi S Jia Yongning Y Zhang Lianhai L Ying Xiangji X Zhang Yan Y Bu Zhaode Z Su Xiangqian X Zhao Gang G Li Ziyu Z Ji Jiafu J

Chinese journal of cancer research = Chung-kuo yen cheng yen chiu 20181001 5

<h4>Objective</h4>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.<h4>Methods</h4>We did this prospective, multicenter, open-label, observational study at gastric surgery departments of 34 hospitals in China. Gastric cancer patients age ...[more]

PMID: 30510361

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Project description:PURPOSE:To report a prospective, multicenter, observational study (ClinicalTrials.gov identifier NCT01609621) of the safety and effectiveness of tibiopedal access and retrograde crossing in the treatment of infrainguinal chronic total occlusions (CTOs). METHODS:Twelve sites around the world prospectively enrolled 197 patients (mean age 71±11 years, range 41-93; 129 men) from May 2012 to July 2013 who met the inclusion criterion of at least one CTO for which a retrograde crossing procedure was planned or became necessary. The population consisted of 64 (32.5%) claudicants (Rutherford categories 2/3) and 133 (67.5%) patients with critical limb ischemia (Rutherford category ?4). A primary antegrade attempt to cross had been made prior to the tibiopedal attempt in 132 (67.0%) cases. Techniques used for access, retrograde lesion crossing, and treatment were at the operator's discretion. Follow-up data were obtained 30 days after the procedure. RESULTS:Technical tibiopedal access success was achieved in 184 (93.4%) of 197 patients and technical occlusion crossing success in 157 (85.3%) of the 184 successful tibial accesses. Failed access attempts were more common in women (9 of 13 failures). The rate of successful crossing was roughly equivalent between sexes [84.7% (50/59) women compared to 85.6% (107/125) men]. Technical success did not differ significantly based on a prior failed antegrade attempt: the access success rate was 92.4% (122/132) after a failed antegrade access vs 95.4% (62/65) in those with a primary tibiopedal attempt (p=0.55). Similarly, crossing success was achieved in 82.8% (101/122) after a failed antegrade access vs 90.3% (56/62) for patients with no prior antegrade attempt (p=0.19). Minor complications related to the access site occurred in 11 (5.6%) cases; no patient had access vessel thrombosis, compartment syndrome, or surgical revascularization. CONCLUSION:Tibiopedal access appears to be safe and can be used effectively for the crossing of infrainguinal lesions in patients with severe lower limb ischemia.

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Dataset Information

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

Publications

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

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