DOI QR코드

DOI QR Code

Gastric salvage after venous congestion during major pancreatic resections: A series of three cases

  • Ravi Chandra Reddy (Gastrointestinal and Hepato-Pancreato-Biliary Service, Department of Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute) ;
  • Vikram Chaudhari (Gastrointestinal and Hepato-Pancreato-Biliary Service, Department of Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute) ;
  • Amit Chopde (Gastrointestinal and Hepato-Pancreato-Biliary Service, Department of Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute) ;
  • Abhishek Mitra (Gastrointestinal and Hepato-Pancreato-Biliary Service, Department of Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute) ;
  • Dushyant Jaiswal (Plastic and reconstructive Service, Department of Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute) ;
  • Shailesh V. Shrikhande (Gastrointestinal and Hepato-Pancreato-Biliary Service, Department of Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute) ;
  • Manish S. Bhandare (Gastrointestinal and Hepato-Pancreato-Biliary Service, Department of Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute)
  • 투고 : 2023.07.17
  • 심사 : 2023.08.30
  • 발행 : 2024.02.29

초록

Pancreatic resections, depending on the location of the tumor, usually require division of the vasculature of either the distal or proximal part of the stomach. In certain situations, such as total pancreatectomy and/or with splenic vein occlusion, viability of the stomach may be threatened due to inadequate venous drainage. We discuss three cases of complex pancreatic surgeries performed for carcinoma of the pancreas at a tertiary care center in India, wherein the stomach was salvaged by reimplanting the veins in two patients and preserving the only draining collateral in one case after the gastric venous drainage was compromised. The perioperative and postoperative course in these patients and the complications were analyzed. None of these 3 patients developed any complication related to gastric venous congestion, and additional gastrectomy was avoided in all these patients. Re-establishment of the Gastric venous outflow after extensive pancreatic resections helps to avoid additional gastric resection secondary to venous congestive changes.

키워드

참고문헌

  1. Skandalakis LJ, Colborn GL, Skandalakis JE, Skandalakis PN, Loukas M, Mitilas P. Chapter 68: Anatomic Considerations in Gastroduodenal Surgery. In: Fischer JE, Bland KI, Callery MP, Clagett GP, Jones DB, LoGerfo FW, et al. eds. Mastery of Surgery. 5th ed. Lippincott Williams and Wilkins, 2007:831-833.
  2. Harao M, Hishinuma S, Tomihawa M, Baba H, Ogata Y. Whole stomach and spleen preserving total pancreatectomy: a new surgical technique for pancreatic cancer. Hepatogastroenterology 2009;56:1549-1551.
  3. Hishida M, Nakao A, Hatsuno T, Yano H, Tanaka T, Takano N, et al. Total pancreatectomy with segmental duodenectomy preserving right gastroepiploic vein. Hepatogastroenterology 2011;58:198-201.
  4. Tanaka M, Ito H, Ono Y, Matsueda K, Mise Y, Ishizawa T, et al. Impact of portal vein resection with splenic vein reconstruction after pancreatoduodenectomy on sinistral portal hypertension: who needs reconstruction? Surgery 2019;165:291-297. https://doi.org/10.1016/j.surg.2018.08.025
  5. Nakao A, Yamada S, Fujii T, Tanaka H, Oshima K, Oshima Y, et al. Gastric venous congestion and bleeding in association with total pancreatectomy. J Hepatobiliary Pancreat Sci 2018;25:150-154. https://doi.org/10.1002/jhbp.523
  6. Sandroussi C, McGilvray ID. Gastric venous reconstruction after radical pancreatic surgery: case report and review of the literature. J Gastrointest Surg 2010;14:1027-1030. https://doi.org/10.1007/s11605-010-1192-0
  7. Kurosaki I, Hatakeyama K. Preservation of the left gastric vein in delayed gastric emptying after pylorus-preserving pancreaticoduodenectomy. J Gastrointest Surg 2005;9:846-852. https://doi.org/10.1016/j.gassur.2005.02.009
  8. Kulu Y, Schmied BM, Werner J, Muselli P, Buchler MW, Schmidt J. Total pancreatectomy for pancreatic cancer: indications and operative technique. HPB (Oxford) 2009;11:469-475. https://doi.org/10.1111/j.1477-2574.2009.00085.x
  9. Sugiyama M, Atomi Y. Pylorus-preserving total pancreatectomy for pancreatic cancer. World J Surg 2000;24:66-70. https://doi.org/10.1007/s002689910013
  10. Loos M, Mehrabi A, Ramouz A, Contin P, Strobel O, Muller-Stich BP, et al. Gastric venous congestion after total pancreatectomy is frequent and dangerous. Ann Surg 2022;276:e896-e904. https://doi.org/10.1097/SLA.0000000000004847
  11. Mehrabi A, Loos M, Ramouz A, Dooghaie Moghadam A, Probst P, Nickel F, et al. Gastric venous reconstruction to reduce gastric venous congestion after total pancreatectomy: study protocol of a single-centre prospective non-randomised observational study (IDEAL Phase 2A) - GENDER study (Gastric vENous DrainagE Reconstruction). BMJ Open 2021;11:e052745.
  12. Kawasaki K, Kanaji S, Kobayashi I, Fujita T, Kominami H, Ueno K, et al. Multidetector computed tomography for preoperative identification of left gastric vein location in patients with gastric cancer. Gastric Cancer 2010;13:25-29. https://doi.org/10.1007/s10120-009-0530-y