A Case of Distal Pancreatectomy after Distal Gastrectomy Preserving Remnant Stomach by Intraoperative Indocyanine Green Fluorography

Abstract

The blood flow of the remnant stomach after distal gastrectomy (DG) is mainly supplied by branches of the splenic artery. Therefore, when performing surgery with resection of the splenic artery in such cases, the blood flow of the remnant stomach becomes the major topic of debate after resection of the splenic artery. A case with pancreatic tail cancer that developed after DG is reported. The patient was an 80-year-old woman who underwent DG with Billroth-I reconstruction for gastric cancer at the age of 39 years. She was referred with a chief complaint of back pain and was diagnosed as having advanced pancreatic tail cancer (cT3N0M0 cStage II A) by detailed examinations. After preoperative chemotherapy, robot-assisted laparoscopic DP and splenectomy were performed. After resection, intraoperative ICG fluorography was performed to evaluate the blood flow of the remnant stomach. After confirming the excellent blood flow of the remnant stomach, it was preserved safely. The patient's postoperative course was uneventful, and the patient was discharged on the 9th postoperative day. We believe that it is possible to safely preserve the remnant stomach by intraoperative ICG fluorescence evaluation even in cases of DP after DG.