Article Abstract

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

Authors: 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


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 (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.

Keywords: Infra-pyloric artery; origination; anatomy; gastric cancer