Ann Hepatobiliary Pancreat Surg.  2022 Nov;26(4):395-400. 10.14701/ahbps.22-016.

Laparoscopic distal pancreatosplenectomy for left-sided pancreatic cancer in patients with radical subtotal gastrectomy for gastric cancer

• Lee KH
• Hong SS
• Kim Ss
• Hwang HK
• Lee WJ
• Kang CM

• KMID: 2536390
• DOI: http://doi.org/10.14701/ahbps.22-016

Abstract

After radical subtotal gastrectomy (RSTG) for stomach cancer, the remnant stomach is supposed to be perfused through the short gastric vessels. What if a patient who received previous RSTG is diagnosed with resectable distal pancreatic cancer? Can radical distal pancreatosplenectomy (DPS) be performed safely without ischemic damage to the remnant stomach? Unfortunately, there are limited studies on this specific clinical issue. Notably, in spite of rare clinical presentation, it is expected to increase due to prolonged survival of patients with resected gastric cancer. Therefore, we aimed to demonstrate the safety and feasibility of the radical DPS in patients with previous RSTG. In this study, we investigated perioperative and long-term survival outcomes of DPS for left-sided pancreatic cancer in patients with previous RSTG.

Keyword

Distal pancreatectomy; Gastrectomy; Laparoscopic; Remnant stomach

Figure

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  Fig. 1 (A) P reoperat ive computed tomography, (B) preoperative endoscopic ultrasound, (C) f inal view of the distal pancreatosplenectomy, (D) well preserved perfusion of the remnant stomach. SA, splenic artery; PV, portal vein; IMV, inferior mesenteric vein; SMV, superior mesenteric vein.

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  Fig. 2 (A) Preoperative computed tomography (CT), (B) preoperative positron emission tomography-computed tomography (PET-CT), (C) division of the pancreas by modified lasso technique, (D) well preserved perfusion of the remnant stomach confirmed by indocyanine green technology.

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  Fig. 3 Long-term oncologic outcomes of patients who underwent radical distal pancreatectomy for pancreatic cancer following previous radical gastrectomy for gastric cancer.

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  Fig. 4 Radiological (axial and coronal) evidence of the collateral vessels supplies to the remnant stomach. (A) Case 1: after distal pancreatectomy. Case 2: before (B) and after (C) distal pancreatectomy. White arrows indicate left inferior phrenic artery; red arrows, jejunal branch from superior mesenteric vein.

Reference

1. Rawla P, Sunkara T, Gaduputi V. 2019; Epidemiology of pancreatic cancer: global trends, etiology and risk factors. World J Oncol. 10:10–27. DOI: 10.14740/wjon1166. PMID: 30834048. PMCID: PMC6396775.

2. Vincent A, Herman J, Schulick R, Hruban RH, Goggins M. 2011; Pancreatic cancer. Lancet. 378:607–620. DOI: 10.1016/S0140-6736(10)62307-0. PMID: 21620466.

3. Luo J, Xiao L, Wu C, Zheng Y, Zhao N. 2013; The incidence and survival rate of population-based pancreatic cancer patients: Shanghai Cancer Registry 2004-2009. PLoS One. 8:e76052. Erratum in: PLoS One 2014;9. DOI: 10.1371/journal.pone.0076052. PMID: 24130758. PMCID: PMC3794034.

4. McGuigan A, Kelly P, Turkington RC, Jones C, Coleman HG, Mc-Cain RS. 2018; Pancreatic cancer: a review of clinical diagnosis, epidemiology, treatment and outcomes. World J Gastroenterol. 24:4846–4861. DOI: 10.3748/wjg.v24.i43.4846. PMID: 30487695. PMCID: PMC6250924.

5. Moekotte AL, Rawashdeh A, Asbun HJ, Coimbra FJ, Edil BH, Jarufe N, et al. 2020; Safe implementation of minimally invasive pancreas resection: a systematic review. HPB (Oxford). 22:637–648. DOI: 10.1016/j.hpb.2019.11.005. PMID: 31836284.

6. de Rooij T, van Hilst J, van Santvoort H, Boerma D, van den Boezem P, Daams F, et al. 2019; Minimally invasive versus open distal pancreatectomy (LEOPARD): a multicenter patient-blinded randomized controlled trial. Ann Surg. 269:2–9. DOI: 10.1097/SLA.0000000000002979. PMID: 30080726.

7. Korrel M, Vissers FL, van Hilst J, de Rooij T, Dijkgraaf MG, Festen S, et al. 2021; Minimally invasive versus open distal pancreatectomy: an individual patient data meta-analysis of two randomized controlled trials. HPB (Oxford). 23:323–330. DOI: 10.1016/j.hpb.2020.10.022. PMID: 33250330.

8. Ko KP. 2019; Epidemiology of gastric cancer in Korea. J Korean Med Assoc. 62:398–406. DOI: 10.5124/jkma.2019.62.8.398.

9. Hong SS, Hwang HK, Lee WJ, Kang CM. 2020; Feasibility and safety of laparoscopic radical distal pancreatosplenectomy with adrenalectomy in advanced pancreatic cancer. Ann Surg Oncol. 27:5235–5236. DOI: 10.1245/s10434-020-08670-9. PMID: 32474822.

10. Kang CM. 2020; ASO author reflections: from concept to real clinical practice of laparoscopic distal pancreatectomy for left-sided pancreatic cancer. Ann Surg Oncol. 27:5237–5238. DOI: 10.1245/s10434-020-08676-3. PMID: 32462529.

11. Chong JU, Kim SH, Hwang HK, Kang CM, Lee WJ. 2017; Yonsei criteria: a clinical reflection of stage I left-sided pancreatic cancer. Oncotarget. 8:110830–110836. DOI: 10.18632/oncotarget.22734. PMID: 29340019. PMCID: PMC5762287.

12. Lee SH, Kang CM, Hwang HK, Choi SH, Lee WJ, Chi HS. 2014; Minimally invasive RAMPS in well-selected left-sided pancreatic cancer within Yonsei criteria: long-term (>median 3 years) oncologic outcomes. Surg Endosc. 28:2848–2855. DOI: 10.1007/s00464-014-3537-3. PMID: 24853839.

13. Kim CY, Lee SH, Jeon HM, Kim HK, Kang CM, Lee WJ. 2014; AFP-producing acinar cell carcinoma treated by pancreaticoduodenectomy in a patient with a previous radical subtotal gastrectomy by gastric cancer. Korean J Hepatobiliary Pancreat Surg. 18:33–37. DOI: 10.14701/kjhbps.2014.18.1.33. PMID: 26155245. PMCID: PMC4492330.

14. Lee D, Lee JH, Choi D, Kang CM, Chong JU, Kim SC, et al. 2017; Surgical strategy and outcome in patients undergoing pancreaticoduodenectomy after gastric resection: a three-center experience with 39 patients. World J Surg. 41:552–558. DOI: 10.1007/s00268-016-3729-1. PMID: 27730351.

15. Fukuta M, Tomibayashi A, Tsuneki T, Nishioka K, Matsuo Y, Mori O, et al. 2020; Pancreaticoduodenectomy after distal gastrectomy: a case series. Int J Surg Case Rep. 76:240–246. DOI: 10.1016/j.ijscr.2020.09.169. PMID: 33053481. PMCID: PMC7566198.

16. Kim SH, Hwang HK, Kang CM, Lee WJ. 2012; Pancreatoduodenectomy in patients with periampullary cancer after radical subtotal gastrectomy for gastric cancer. Am Surg. 78:E164–E167. DOI: 10.1177/000313481207800319.

17. Kawasaki Y, Hwang HK, Kang CM, Natsugoe S, Lee WJ. 2018; Improved perioperative outcomes of laparoscopic distal pancreatosplenectomy: modified lasso technique. ANZ J Surg. 88:886–890. DOI: 10.1111/ans.14351. PMID: 29266719.

18. De Nardi P, Elmore U, Maggi G, Maggiore R, Boni L, Cassinotti E, et al. 2020; Intraoperative angiography with indocyanine green to assess anastomosis perfusion in patients undergoing laparoscopic colorectal resection: results of a multicenter randomized controlled trial. Surg Endosc. 34:53–60. DOI: 10.1007/s00464-019-06730-0. PMID: 30903276.

19. Abdelwahab M, Spataro EA, Kandathil CK, Most SP. 2019; Neovascularization perfusion of melolabial flaps using intraoperative indocyanine green angiography. JAMA Facial Plast Surg. 21:230–236. DOI: 10.1001/jamafacial.2018.1874. PMID: 30730539. PMCID: PMC6537835.

20. Asari S, Toyama H, Goto T, Yamashita H, Nanno Y, Ishida J, et al. 2021; Indocyanine green (ICG) fluorography and digital subtraction angiography (DSA) of vessels supplying the remnant stomach that were performed during distal pancreatectomy in a patient with a history of distal gastrectomy: a case report. Clin J Gastroenterol. 14:1749–1755. DOI: 10.1007/s12328-021-01493-5. PMID: 34342840.