Ann Surg Treat Res.  2022 Sep;103(3):145-152. 10.4174/astr.2022.103.3.145.

Safety of performing distal pancreatosplenectomy in patients who underwent distal gastrectomy previously: a multicenter cohort analysis with systematic literature review

• Park SE
• Paik KY
• You DD
• Lee TY
• Kim KH
• Na GH
• Park JH
• Hong TH

• KMID: 2532926
• DOI: http://doi.org/10.4174/astr.2022.103.3.145

Abstract

Purpose
In patients who have previously undergone subtotal gastrectomy (STG), the remnant stomach is supplied with arterial blood through the splenic artery. It is currently unclear whether the remnant stomach can be safely preserved when performing distal pancreatosplenectomy (DPS) in these patients. Thus, this study aimed to evaluate the safety and feasibility of performing DPS in patients who had undergone a previous STG.
Methods
A multicenter cohort study was performed to identify patients who underwent DPS. Electronic medical data of Clinical Data Warehouse from 7 representative high-volume centers in 5 cities were retrospectively reviewed. A propensity score-matched analysis was performed to match patients who had no history of upper abdominal surgery with patients who had undergone a previous STG.
Results
Fourteen DPS patients who had a history of STG (STG group) were studied and matched to 70 patients who underwent DPS without any history of upper abdominal surgery (non-STG group). All patients in the STG group had the remnant stomach preserved. In most patients, the blood vessel supplying blood to the remnant stomach was the left inferior phrenic artery. There was no significant difference in the incidence of stomach-related complications or length of hospital stay between the 2 groups.
Conclusion
Our study results suggest that the remnant stomach could be safely preserved when performing DPS in patients with a prior STG. However, it is necessary to carefully evaluate the vascular structure of the remnant stomach through preoperative imaging study and closely observe changes to the blue stomach during the operation.

Keyword

Distal pancreatectomy; Gastrectomy; Short gastric artery; Splenic artery

Figure

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  Fig. 1 (A) Preoperative CT for patient 9. (B) Postoperative CT showing the developed left inferior phrenic artery (arrow) in patient 9.

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  Fig. 2 CT images before (A) and after (B) surgery showed that blood vessels (circles) supplying blood to the remnant stomach were naturally expanded after the operation.

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