Pancreas-preserving total gastrectomy for gastric cancer
Arch Surg 2000; 135:89-94
Doglietto GB, Pacelli F, Caprino P, Bossola M, Di Stasi C.
Department of Digestive Surgery, Catholic University, Rome, Italy.
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.
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.
Both primary and referral hospital care.
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.
MAIN OUTCOME MEASURES:
Surgical complications, postoperative deaths, and survival.
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.
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.