title: Preservation of the left gastric artery on the basis of anatomical features in patients undergoing distal pancreatectomy with celiac axis en-bloc resection (DP-CAR).
abstract: BACKGROUND
  The incidence of delayed gastric emptying (DGE) is high in patients undergoing distal pancreatectomy with celiac axis en-bloc resection (DP-CAR).
  
  
  METHODS
  The medical records of 37 consecutive patients who underwent DP-CAR were evaluated for the incidence of DGE in 23 patients (62 %) with left gastric artery (LGA)-resecting DP-CAR (conventional DP-CAR) compared with 14 patients (38 %) who underwent distal pancreatectomy with resection of the common hepatic artery and splenic artery, with preservation of the LGA (modified DP-CAR) for pancreatic carcinoma. The patients with tumors situated more than 10 mm away from the antecedent branching LGA underwent modified DP-CAR.
  
  
  RESULTS
  Antecedent branching of the LGA was found in 19 patients (51 %) in this series. In the conventional DP-CAR group, the LGA was involved in 20 patients (87.0 %). The International Study Group of Pancreatic Surgery (ISGPS) grades for the conventional DP-CAR group were as follows: no DGE = 43 %, grade A = 26 %, B = 13 %, and C = 17 %. In the modified DP-CAR group, they were as follows: no DGE = 93 %, grade A = 7 %, and grade B/C = 0 %. The R0 rate was higher in the modified DP-CAR group (79 %) than in the conventional DP-CAR group (43 %) (p = 0.048). Univariate analyses revealed resection of LGA, residual tumor status (R1), and clinically relevant (Grade B, C) pancreatic fistula increased the risk of DGE. On multivariate analysis, resection of the LGA was an independent risk factor for increased incidence of DGE.
  
  
  CONCLUSIONS
  Modified DP-CAR, when it is feasible, significantly reduces the incidence of DGE in comparison with conventional DP-CAR.
authors.affiliation: Second Department of Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama, Japan.
authors.forename: Ken-Ichi
authors.initials: K
authors.lastname: Okada
authors.forename: Manabu
authors.initials: M
authors.lastname: Kawai
authors.forename: Masaji
authors.initials: M
authors.lastname: Tani
authors.forename: Seiko
authors.initials: S
authors.lastname: Hirono
authors.forename: Motoki
authors.initials: M
authors.lastname: Miyazawa
authors.forename: Atsushi
authors.initials: A
authors.lastname: Shimizu
authors.forename: Yuji
authors.initials: Y
authors.lastname: Kitahata
authors.forename: Hiroki
authors.initials: H
authors.lastname: Yamaue
mesh_terms: D000328:Adult; D000368:Aged; D002277:Carcinoma / Q000601:surgery; D002445:Celiac Artery / Q000601:surgery*; D005260:Female; D005746:Gastric Emptying; D006499:Hepatic Artery / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D018365:Neoplasm, Residual; D059351:Organ Sparing Treatments / Q000379:methods*; D010180:Pancreatectomy / Q000379:methods*; D010185:Pancreatic Fistula / Q000209:etiology*; D010190:Pancreatic Neoplasms / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology / Q000503:physiopathology*; D012307:Risk Factors; D013157:Splenic Artery / Q000601:surgery; D013997:Time Factors
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