title: Is preservation of the remnant stomach safe during distal pancreatectomy in patients who have undergone distal gastrectomy?
abstract: BACKGROUND
  Whether the remnant stomach can be safely preserved when performing distal pancreatectomy (DP) in patients with a prior distal gastrectomy (DG) remains unclear because the remnant stomach and pancreatic body/tail share an arterial blood supply via the splenic artery (SPA).
  
  
  METHODS
  A total of 18 patients with prior DG who underwent DP were enrolled in this study. Clinicopathologic data were retrospectively analyzed with a focus on management of the remnant stomach and complications related to ischemia of the remnant stomach. Additionally, intraoperative indocyanine green (ICG) fluorescence angiography was performed to visualize the blood flow and circulation in the remnant stomach.
  
  
  RESULTS
  Ten patients underwent a standard DP (DP in conjunction with splenectomy and division of the SPA) with preservation of the remnant stomach. The entire stomach was preserved in seven patients, and three underwent concomitant partial resection of the remnant stomach. No patients in whom the entire remnant stomach was preserved developed postoperative complications associated with it, whereas two of the three patients who underwent partial resection of the remnant stomach developed severe ischemic complications. Intraoperative ICG fluorescence angiography revealed a caudally directed circulation of blood from the esophagogastric junction through the intramural capillary network in the remnant stomach.
  
  
  CONCLUSIONS
  When performing DP in patients with a prior DG, preservation of the entire remnant stomach was a safe procedure because of the presence of an intramural network that supplies blood to the remnant stomach. In contrast, partial resection of the remnant stomach could be dangerous because of the potential for severe ischemic complications.
authors.affiliation: Department of Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, 1-3-3 Nakamichi, Higashinari-ku, Osaka 537-8511, Japan. takahasi-hi@mc.pref.osaka.jp
authors.forename: Hidenori
authors.initials: H
authors.lastname: Takahashi
authors.forename: Satoshi
authors.initials: S
authors.lastname: Nara
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Ohigashi
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Sakamoto
authors.forename: Kunihto
authors.initials: K
authors.lastname: Gotoh
authors.forename: Minoru
authors.initials: M
authors.lastname: Esaki
authors.forename: Terumasa
authors.initials: T
authors.lastname: Yamada
authors.forename: Kazuaki
authors.initials: K
authors.lastname: Shimada
authors.forename: Masahiko
authors.initials: M
authors.lastname: Yano
authors.forename: Tomoo
authors.initials: T
authors.lastname: Kosuge
authors.forename: Osamu
authors.initials: O
authors.lastname: Ishikawa
mesh_terms: D000368:Aged; D005260:Female; D005456:Fluorescent Dyes; D005743:Gastrectomy / Q000379:methods*; D006801:Humans; D007208:Indocyanine Green; D007511:Ischemia / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D010180:Pancreatectomy / Q000379:methods*; D010190:Pancreatic Neoplasms / Q000601:surgery*; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D012189:Retrospective Studies; D013270:Stomach / Q000098:blood supply* / Q000601:surgery; D013274:Stomach Neoplasms / Q000601:surgery; D013276:Stomach Ulcer / Q000601:surgery; D016896:Treatment Outcome
chemical_list: D005456:Fluorescent Dyes; D007208:Indocyanine Green