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Preoperativecomputedtomographyshowed avascularanomalyoftypeVIinAdachi'sclassification.Thepatientunderwentlaparoscopicdistalgastrectomy with D1+ lymph node dissection. The patient's postoperative course was uneventful, and the patientwasdischarged11daysaftersurgery.Inthiscase,thecommonhepaticarterycouldn'tbedetectedatthesuperiorborderofthepancreas,thelefthepaticarterydivergedfromtheleftgastricarteryand the right hepatic artery arose from the superior mesenteric artery. Since it was diagnosed as Adachi's typeVIgroup28.ItwaspossibletoperformlaparoscopicsurgerysafelyforgastriccancerwithAdachi's typeVIgroup28usingthedouble-dooropeningstyle.Itisimportanttounderstandthearterialrunning patternbeforetheoperation.

Background This retrospective study aimed to elucidate the relationships between short-term outcomes following total pelvic exenteration combined with sacral resection (TPES) and operative techniques in patients with rectal cancer. Methods Data regarding sex, age, body mass index, neoadjuvant therapy, location of sacral resection (“Upper” or “Lower” relative to the level between the 3rd and 4th sacral segment), operative time, bleeding, and curability (R0/R1) were collected and compared to determine their association with complications exhibiting a Clavien–Dindo grade higher than III. Results The complication rate was significantly higher for recurrent cancers than for primary cancers (p = 0.007), and for “Upper” resection than for “Lower” resection (p = 0.078). Significant differences were observed when complication rates for “Upper” and “Lower” resection were compared between primary and recurrent cancers (p = 0.007). Conclusion In patients with recurrent rectal cancer, “Upper” sacral resection during TPES is associated with a high complication rate, highlighting the need for careful monitoring.

Background This retrospective study aimed to demonstrate surgical operative approach of total pelvic exenteration combined with sacral resection with rectal cancer and elucidate the relationships between the level of sacral resection and short-term outcomes. Methods Twenty cases were selected. Data regarding sex, age, body mass index, neoadjuvant therapy, location of sacral resection (“Upper” or “Lower” relative to the level between the 3rd and 4th sacral segment), operative time, bleeding, and curability (R0/R1) were collected and compared to determine their association with complications exhibiting a Clavien-Dindo grade III. Results The complication rate was significantly higher for recurrent cancers (n = 10, 76.9%) than for primary cancers (n = 1, 14.3%) ( P = .007), and for “Upper” resection (n = 8, 72.7%) than for “Lower” resection (n = 3, 33.3%) ( P = .078). Significant differences were observed when complication rates for “Lower” and primary cancer resection (n = 3, .0%) were compared between “Upper” and recurrent cancers (n = 8, 100.0%) ( P = .007). Conclusion In patients with recurrent rectal cancer, “Upper” sacral resection during total pelvic exenteration is associated with a high complication rate, highlighting the need for careful monitoring.

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