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. CONCLUSION: Modified DP-CAR, when it is feasible, significantly reduces the incidence of DGE in comparison with conventional DP-CAR.
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. CONCLUSION: Modified DP-CAR, when it is feasible, significantly reduces the incidence of DGE in comparison with conventional DP-CAR.
Authors: Lee M Ocuin; Jennifer L Miller-Ocuin; Stephanie M Novak; David L Bartlett; J Wallis Marsh; Allan Tsung; Kenneth K Lee; Melissa E Hogg; Herbert J Zeh; Amer H Zureikat Journal: HPB (Oxford) Date: 2016-07-08 Impact factor: 3.647