Decision for Preservation or Ligation of Aberrant Left Hepatic Artery Using Fluorescence Imaging in Minimally Invasive Gastrectomy: A Prospective Non-randomized Comparative Study.

Authors

Ji Eun Jung, Shiyeol Jun, Seyeol Oh, In Gyu Kwon, Sung Hoon Noh, Hyoung-Il Kim

Published in

Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract. Pages 102554. Aug 14, 2026. Epub Aug 14, 2026.

Abstract

In radical gastrectomy, an aberrant left hepatic artery(ALHA) preservation should consider both oncologic safety and liver-related complication. This study aimed to develop the algorithm to decide the ALHA preservation or ligation, using near-infrared fluorescence imaging for liver perfusion during surgery.
This multicenter, prospective, non-randomized comparative study included 50 patients undergoing minimally invasive gastrectomy for gastric cancer. During surgery, indocyanine green(ICG) was injected intravenously after temporarily clamping ALHA, and the liver perfusion of the left hepatic lobe was assessed based on fluorescence imaging. Patients were categorized into three groups based on the extent of the fluorescence defect: No Perfusion(NP), Partial Perfusion(PP) and Complete Perfusion(CP). ALHA was preserved in the NP group and ligated in the PP and CP groups. Postoperative liver dysfunction was evaluated by monitoring changes in liver enzyme levels.
Between December, 2021 and June, 2023, 50 patients were enrolled: 15 in the NP group, 12 in the PP group, and 23 in the CP group. No ICG injection-related adverse events were reported. A significant increase in liver enzyme levels was observed in the PP group. Specifically, AST changes differed significantly among the NP, PP, and CP groups on postoperative day(POD)1(95.95±104.5%,303.73±383.4%,109.39±99.6%; p=0.049) and POD5(-12.43±31.1%,7.63±16.5%,-19.51±22.1%; p=0.037). ALT changes also differed on POD3(27.73±58.5%,313.68±417.1%,127.68±176.9%; p=0.036) and POD5(8.19±52.9%,185.47±148.3%,32.43±77.1%; p=0.004). All liver enzyme levels normalized within five days postoperatively, and no severe liver-related complications were observed up to one month after surgery. Although ALHA diameter differed among the perfusion groups, ALHA subtype distribution was similar across the groups.
Real-time near-infrared fluorescence imaging safely guided ALHA management during gastrectomy by evaluating hepatic perfusion, minimizing liver dysfunction risk. However, further studies are required to evaluate the safety of ALHA ligation across all perfusion patterns.
NCT05971069.

PMID:
42600732
Bibliographic data and abstract were imported from PubMed on 15 Aug 2026.

Read full publication at:
Please sign in to see all details.

Stats

1-terrible, 9-excellent. How would you rate this publication? Sign in in to submit your rating.

Post a comment

You need to be signed in to post comments. You can sign in here.

Comments

There are no comments yet.