Robotic Distal Gastrectomy with D2 Lymphadenectomy for Gastric Cancer in a Patient with an Unclassifiable Celiac Arterial Anomaly: A Case Report.

INTRODUCTION: Suprapancreatic lymph node dissection during gastric cancer surgery is technically challenging, particularly in the presence of celiac arterial system-related vascular anomalies. However, some rare arterial configurations do not clearly fit within existing classification systems, making surgical planning difficult. Herein, we report a case of gastric cancer with an unclassifiable celiac arterial anomaly that was managed using a robotic approach. CASE PRESENTATION: A 77-year-old woman presented with several weeks of persistent epigastric pain and was referred to our hospital. Imaging studies revealed gastric cancer and an unusual vascular anatomy in which the left gastric, splenic, common hepatic, and superior mesenteric arteries arose independently from the abdominal aorta, with the common hepatic artery coursing dorsal to the portal vein. The patient underwent robotic distal gastrectomy with D2 lymphadenectomy. Preoperative 3D-CTA enabled accurate anatomical assessment. Portal vein taping facilitated safe suprapancreatic lymph node dissection. The postoperative course was uneventful. CONCLUSIONS: This case demonstrates that even unclassifiable vascular anomalies can be safely managed with detailed preoperative anatomical assessment and appropriate intraoperative strategies, providing a practical approach for surgical decision-making in anatomically complex gastric cancer cases.