The Role of the Appleby Operation and Arterial Resection in the Multimodality Management of Borderline Resectable Pancreatic Cancer

Okada, Ken-ichi; Yamaue, Hiroki

doi:10.1007/978-3-319-22780-1_16

Cited by 2 publications

(1 citation statement)

References 49 publications

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“…They have adopted it as a radical pancreatectomy for borderline resectable pancreatic body carcinoma [9] . Ischemic gastropathy with a considerable incidence [1,3,10] can lead to lethal complications such as stomach necrosis, poor nutritional status, and failure to complete postoperative adjuvant chemotherapy.…”

Section: Discussionmentioning

confidence: 99%

Left Gastric Artery Reconstruction after Distal Pancreatectomy with Celiac Axis En-Bloc Resection: How We Do It

Okada¹,

Hirono²,

Kawai³

et al. 2017

Gastrointest Tumors

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Background/Aims: Ischemic gastropathy remains as a persistent problem after left gastric artery (LGA) resection in distal pancreatectomy with celiac axis en-bloc resection (DP-CAR). The middle colic artery (MCA) was found to be a useful vessel for compromised collateral flow. However, intraoperative gross evaluation of gastric ischemia is technically difficult even after artery reconstruction. Methods: We performed LGA reconstruction by MCA-LGA bypass after LGA-resecting DP-CAR assisted by intraoperative indocyanine green fluorescence imaging (ICG) blood flow evaluation in a clinical trial (UMIN000020414). The LGA was reconstructed with the MCA microscopically by plastic surgeons with an everting interrupted suture in end-to-end anastomosis. Results: We could evaluate ICG blood flow not only in the reconstructed artery, but also simultaneously in the gastric wall through a monitor connected to a detector. We could also assess the congestive status of the gastric wall by ICG disappearance from the gastric wall. Conclusion: We present LGA reconstruction by MCA-LGA bypass after LGA-resecting DP-CAR. We conducted a perioperative assessment of ischemic gastropathy to confirm the feasibility and safety of this procedure.

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