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

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.

Total pancreatectomy with remnant stomach preservation in a patient with a history of proximal gastrectomy and interposed jejunal reconstruction with right gastroepiploic conduit preservation: a case report

“…In the present case, when the right gastroepiploic conduit was resected, only the right gastric artery and vein remained as vessels of the remnant stomach. Previous studies reported successful remnant stomach preservation in patients undergoing distal pancreatectomy following distal gastrectomy despite few stomach vessels [ 25 – 27 ]. This may be explained by the blood flow from the anastomosed intestinal wall that developed during the interval from the previous gastrectomy, which supports the blood supply to the remnant stomach.…”

Simultaneous robotic distal gastrectomy and distal pancreatectomy: Avoiding total gastrectomy using indocyanine green fluorescence imaging

“…Some studies have reported the safety of asynchronous DP in patients who have undergone DG 1,2 . However, there are very few reports on simultaneous DG and DP 3 .…”

“…Some studies have reported the safety of asynchronous DP in patients who have undergone DG. 1,2 However, there are very few reports on simultaneous DG and DP. 3 We report a case of simultaneous DG and DP for gastric and pancreatic cancer; this is the first known case of the procedure being robotically performed.…”