Surgical and Radiologic Anatomy

, Volume 40, Issue 7, pp 749–756 | Cite as

Clinical evaluation of the aberrant left hepatic artery arising from the left gastric artery in esophagectomy

  • Harufumi Maki
  • Hitoshi Satodate
  • Shouichi Satou
  • Kentaro Nakajima
  • Atsuki Nagao
  • Kazuteru Watanabe
  • Satoshi Nara
  • Kaoru Furushima
  • Yasushi Harihara
Anatomic Bases of Medical, Radiological and Surgical Techniques



The left gastric artery (LGA) is commonly severed when the gastric tube is made for esophageal reconstruction. Sacrifice of the LGA can cause liver ischemic necrosis in patients with an aberrant left hepatic artery (ALHA) arising from the LGA. We experienced a case of life-threatening hepatic abscess after severing the ALHA. Therefore, the purpose of this study is to evaluate clinical outcomes of severing the ALHA.


We retrospectively enrolled 176 consecutive patients who underwent esophagectomy with gastric tube reconstruction. They were classified into the ALHA (N = 16, 9.1%) and non-ALHA (N = 160, 90.9%) groups. Univariate analysis was performed to compare the clinicopathological variables. Long-term survival was analyzed using the Kaplan–Meier method in matched pair case–control analysis.


The postoperative morbidities were not statistically different between the two groups, although serum alanine aminotransferase levels on postoperative days 1 and 3 were significantly higher in the ALHA group (36 IU/L, 14–515; 32 IU/L, 13–295) than in the non-ALHA group (24 IU/L, 8–163; 19 IU/L, 6–180), respectively (p = 0.0055; p = 0.0073). Overall survival was not statistically different between the two groups (p = 0.26).


Severe hepatic abscess occurred in 6.3% of the patients with the ALHA after esophagectomy, even though the results presented here found no statistical differences in morbidity or mortality with or without the ALHA. Surgeons should probably attempt to preserve the ALHA especially in patients with altered liver function while making a gastric tube for esophageal reconstruction.


Aberrant left hepatic artery Esophagectomy Esophageal cancer Hepatic abscess 



Left gastric artery


Aberrant left hepatic artery


Computed tomography


Serum aspartate aminotransferase level


Serum alanine aminotransferase level


Serum total bilirubin level


Chronic obstructive pulmonary disease


Authors’ contribution

HM: project development, data collection and analysis and manuscript writing. HS: manuscript editing. SS, KN, AN, KW, SN and KF: rounds on patients. YH: manuscript editing.



Compliance with ethical standards

Conflict of interest

We have no conflict of interest to declare.

Supplementary material

276_2018_2022_MOESM1_ESM.docx (28 kb)
Supplementary material 1 (DOCX 27 KB)


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Copyright information

© Springer-Verlag France SAS, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of SurgeryNTT Medical Center TokyoTokyoJapan

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