Pancreas-preserving total gastrectomy for gastric cancer.
BACKGROUND
Pancreas-preserving total gastrectomy for gastric cancer has been proposed to remove lymph nodes along the upper border of the pancreas without performing a distal pancreatic resection. However, the original technique includes the ligation of the splenic artery at its origin and thus carries the risk of pancreatic necrosis.


OBJECTIVE
A technique of pancreas-preserving total gastrectomy that includes ligation of the splenic artery approximately 5 cm distally from the root may reduce the risk of postoperative pancreatic necrosis.


METHODS
Case series.


METHODS
Both primary and referral hospital care.


METHODS
Hospital records of 228 consecutive patients who, according to a personal technique, underwent D3 pancreas-preserving total gastrectomy for gastric cancer from 1981 to 1997 were reviewed.


METHODS
Surgical complications, postoperative deaths, and survival.


RESULTS
Hospital morbidity and mortality were 33.3% and 3.9%, respectively. No patients experienced pancreatic necrosis. The 5-year survival rate after curative resection was 53.6%: 96.9% for stage IA, 76.3% for stage IB, 63.0% for stage II, 35.6% for stage IIIA, 27.0% for stage IIIB, and 20.3% for stage IV (N3-positive patients) disease.


CONCLUSIONS
Results of the present study show the efficacy of this method of radical resection for gastric cancer as demonstrated by the low incidence of postoperative complications and high survival rates.
Doglietto
G B
GB
Department of Digestive Surgery, Catholic University, Rome, Italy.
Pacelli
F
F
Caprino
P
P
Bossola
M
M
Di Stasi
C
C
D000328:Adult; D000368:Aged; D005260:Female; D005743:Gastrectomy / Q000379:methods*; D017052:Hospital Mortality; D006801:Humans; D008197:Lymph Node Excision / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010179:Pancreas / Q000098:blood supply* / Q000601:surgery; D019283:Pancreatitis, Acute Necrotizing / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D012307:Risk Factors; D013157:Splenic Artery / Q000601:surgery*; D013274:Stomach Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D015996:Survival Rate