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

Affiliations
  • 1Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
  • 2Department of Radiology and Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea
  • 3Yonsei Pancreatobiliary Cancer Center, Yonsei Cancer Center, Severance Hospital, Seoul, Korea

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

  • 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.

  • 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.

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

  • 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.


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