title: Successful distal gastrectomy after distal pancreatectomy combined with splenectomy by assuring the blood flow to the remnant stomach from the left inferior phrenic artery.
abstract: OBJECTIVE
  The current literature would suggest that patients with gastric cancer who have a previous history of ligation of the splenic artery undergo total gastrectomy. However, an analysis of the risk factors for postoperative complications in elderly patients showed a higher rate of morbidities for total gastrectomy compared to subtotal gastrectomy. Case
  
  
  METHODS
  We herein report a rare case of successful distal gastrectomy in a 78-year-old female diagnosed with gastric cancer with a previous history of distal pancreatectomy combined with splenectomy, because an adequate blood flow was provided by the fundic branches from the left inferior phrenic artery. Preoperative computed tomography demonstrated a ligated splenic artery and left gastric artery with developed fundic branches from the left inferior phrenic artery. The intraoperative findings showed a sufficient blood flow to the proximal stomach after ligation of all main gastric arteries, thus suggesting that the gastric remnant could be supplied by the fundic branches from the LIPA. The patient’s postoperative course was uneventful.
  
  
  CONCLUSIONS
  This case suggests that a distal gastrectomy is a possible treatment modality even after distal pancreatectomy combined with splenectomy.
authors.forename: Marie
authors.initials: M
authors.lastname: Hanaoka
authors.forename: Hisashi
authors.initials: H
authors.lastname: Shinohara
authors.forename: Shusuke
authors.initials: S
authors.lastname: Haruta
authors.forename: Tomonori
authors.initials: T
authors.lastname: Tate
authors.forename: Takatsugu
authors.initials: T
authors.lastname: Fujii
authors.forename: Masaki
authors.initials: M
authors.lastname: Ueno
authors.forename: Harushi
authors.initials: H
authors.lastname: Udagawa
mesh_terms: D000368:Aged; D001158:Arteries / Q000503:physiopathology; D018279:Carcinoma, Signet Ring Cell / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D005260:Female; D005743:Gastrectomy; D018530:Gastric Stump / Q000098:blood supply*; D005773:Gastroscopy; D006801:Humans; D008026:Ligation; D010180:Pancreatectomy; D013152:Splanchnic Circulation; D013156:Splenectomy; D013157:Splenic Artery / Q000503:physiopathology / Q000601:surgery; D013274:Stomach Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome