Background: Cardiopulmonary complications and liver dysfunction are also specific complications and problems associated with laparoscopic surgery. The main causes of postoperative liver dysfunction, which may often occur after laparoscopic surgery, include carbon dioxide pneumoperitoneum and ligation of the aberrant left hepatic artery. Hepatic steatosis may develop as a natural consequence of neoadjuvant therapy, although rarely, owing to chemotherapy. Nathanson retractor may cause a prolonged elevation in liver enzymes of these patients compared with those who do not receive neoadjuvant therapy. Materials and Methods: The data of 151 patients who underwent laparoscopic radical gastrectomy between January 2017 and January 2022 for histologically proven primary gastric cancer in our clinic were retrospectively reviewed. Results: The mean length of hospital stay was 6.21 days. The mean time normalization of the aspartate aminotransferase (AST) value was 2.45 ± 1.83 (range, 0–12) days postoperatively. The analysis of the correlation between the preoperative and postoperative 1-day values of alanine aminotransferase (ALT) and AST revealed a significant difference between the preoperative and postoperative 1-day median values of both parameters ( P < .001). Each one unit increase in ALT led to an increase of 0.338 days in the length of intensive care stay and an increase of 0.345 days in the overall length of hospital stay. As the time to normalization of the AST value increased, the length of both intensive care stay and hospital stay increased. Each one unit increase in AST resulted in an increase of 0.316 days in the length of intensive care stay and an increase of 0.376 days in the overall length of hospital stay. Conclusion: Alternative retraction methods can be used safely in laparoscopic surgery for gastric cancer patients receiving neoadjuvant therapy. We are of the opinion that the Nathanson retractor should be used only during dissection of the relevant regions to shorten the intraoperative intermittent release or the time of use.

The clinical significance of the albumin–bilirubin (ALBI) grade in patients with pancreatic head cancer (PHC) undergoing surgery is unknown. Preoperative ALBI grade is believed to be influenced by tumor burden. This study aimed to develop and validate the ALBI grade as a preoperative prognostic model for predicting the survival of patients with PHC. This is a retrospective study of Whipple procedures performed on PHC patients between January 2013 and December 2022. ALBI grade was compared to age, gender, type of operation, presence of complications, type of complications, Clavien-Dindo classification, total bilirubin levels, and albumin levels. Of the series, 46 (41.1%) of the 112 patients were female, while 66 (58.9%) were male. The rate of complications following Whipple procedures was 36.6% (n = 41). The overall mortality hazard ratio increased significantly with increasing ALBI grades (HR: 1538, hazard ratio mean: −1602). Hospital mortality increased 2.84 times as the ALBI grade increased. The model’s accuracy of 88.4% showed that the ALBI grade directly affected both the overall mortality rate and the hospital rate. But there was no statistically significant difference between the ALBI grade and other variables. Multivariate regression analysis identified the preoperative ALBI grade as an independent predictor of mortality (P = .006). To the best of our knowledge, this is the first study to identify preoperative ALBI grade as an independent predictor of survival in PHC. It was found that the ALBI grade of −1602 was a new grading system that would be more predictive of mortality in PHC.

Introduction: Aberrant left hepatic artery (ALHA) can exist in up to 25% of the population. The presence of ALHA during lymph node (LN) dissection in gastric cancer may complicate the process. In this study, we aimed to evaluate the existence rate, management, and consequences of ALHA in our laparoscopic gastrectomy series. Patients and Methods: Demographical and clinical data of laparoscopically operated 158 consecutive gastric cancer patients were collected retrospectively. Study patients were divided into three groups according to absence, existence and preservation, and existence and sacrification of ALHA. Harvested LN numbers, operation time, and postoperative alanine aminotransferase (ALT), aspartate aminotransferase (AST), and lactate dehydrogenase values on consecutive days were analyzed using Kruskal–Wallis and Mann–Whitney U tests. P < .05 is accepted as significant. Results: The median AST and ALT values of the ALHA-sacrificed group were higher than those of the group without ALHA and the ALHA-preserved group on the 1st, 3rd, and 5th postoperative days (P < .05). On the 10th day, liver enzymes returned to normal values. Conclusion: Adequate and appropriate dissection of LNs while preserving ALHA can be performed without prolonging the operation time. Sacrification of ALHA causes an increase in liver enzymes, with spontaneous recovery in most cases.