Laparoscopic total gastrectomy for advanced gastric cancer with anomalous splenic vein and hepatic artery: a case report.

[BACKGROUND] Surgery for gastric cancer involves gastrectomy with lymph node dissection based on established arterial landmarks. While arterial variations around the celiac axis are well recognized, venous anomalies such as aberrant courses of the splenic vein have received limited attention, and their potential impact on the safety of standard lymphadenectomy remains unclear. We report a case of laparoscopic total gastrectomy complicated by an aberrant course of the splenic vein that posed a potential risk of vascular injury during standard lymph node dissection.

[CASE PRESENTATION] An 80-year-old man with type 3 advanced gastric cancer of the lesser curvature of the gastric body was referred for surgery. Contrast-enhanced computed tomography could not be performed because of chronic renal dysfunction, limiting preoperative vascular assessment. Intraoperatively, an aberrant common hepatic artery arising from the superior mesenteric artery and a left hepatic artery branching from the left gastric artery were identified. In addition, the splenic vein coursed ventrally to the celiac artery and was located within the standard lymphadenectomy plane, posing a potential risk of venous injury during standard dissection. Laparoscopic total gastrectomy with D2 lymph node dissection was successfully completed with careful dissection and splenic vein taping, without intraoperative complications.

[CONCLUSIONS] Even during standard lymphadenectomy based on arterial landmarks, aberrant courses of the splenic vein may increase the risk of vascular injury, particularly when preoperative imaging is limited. Awareness of potentially hazardous venous anatomy, in addition to arterial variations, is essential for safe laparoscopic gastrectomy.