Measurement of Pancreatic Blood Flow to Prevent Pancreatic Juice Leakage after Pancreas-Preserving Total Gastrectomy for Gastric Cancer

Abstract

In patients with gastric cancer, distal pancreatectomy was frequently performed for complete removal of the lymph nodes along the splenic artery, but this procedure sometimes induced pancreatic juice leakage, subphrenic abscess, and postoperative diabetes. To avoid these complications, pancreas-preserving total gastrectomy (PP) was developed by Maruyama et al. [World J Surg 1995; 19:552-536], with which the spleen, splenic artery, and fatty connective tissue including lymph nodes could be removed completely without distal pancreatectomy. From 1988 to 1995, 36 patients underwent PP in our department. Although there were no operative deaths and no patient developed postoperative diabetes, pancreatic juice leakage was observed in 4 patients (11.1%). We assumed that ischemia of the distal pancreas may have caused this pancreatic juice leakage and investigated the relationship between pancreatic blood flow (PBF) and this complication in 12 recent patients. A significant negative correlation between PBF in the pancreatic tail and the peak amylase level (PAL) in the drain fluid was demonstrated. Two patients with PBF values of 4.5 and 5.2 ml/min/100 g tissue, respectively, and a PAL of more than 2 x 10(5) U/l developed pancreatic juice leakage, whereas the 10 patients without this complication had PBF values above 6 ml/min/100 g tissue and a PAL of less than 2 x 10(4) U/l. These results suggest that measurement of PBF may be useful to predict the leakage of pancreatic juice after PP and that distal pancreatectomy may be preferable when PBF is extremely low.