In recent years, advancements in surgical procedures and perioperative management have improved cancer treatments, thereby expanding surgical indications for pancreatic cancer treatment. In distal pancreatectomy with celiac axis resection (DP-CAR) for pancreatic cancer, the left gastric artery (LGA) , which is the main feeding vessel of the stomach, may be dissected with the celiac artery. As a result, there is a high possibility of ischemic gastropathy due to decreased blood flow in the stomach. In order to avoid ischemic gastropathy after DP-CAR, a retrospective study was conducted on three cases in which the LGA was reconstructed with the middle colic artery (MCA) . In all cases, intraoperative indocyanine green angiography revealed sufficient blood flow to the stomach wall. Postoperative contrast-enhanced computed tomography did not demonstrate stenosis or occlusion of the vascular anastomosis, and ischemic gastropathy was not observed. In DP-CAR, reconstruction of the LGA with the MCA may prevent postoperative ischemic gastropathy.
