A Case of Successful Stomach-Preserving Distal Pancreatectomy Involving Celiac Axis Resection without Reconstruction of Hepatic Artery for the Treatment of Pancreatic Body Cancer, Utilizing the Real-Time Intraoperative Assessment of Hepatic and Gastric Arterial Flow and Liver Function with a Photodynamic Eye and DDG Analyzer

• Published in: The Japanese Journal of Gastroenterological Surgery Vol. 44; no. 6; pp. 721 - 728
• Main Authors: Nagata, Shigenori, Tomita, Yasuhiko, Takahashi, Hidenori, Ohigashi, Hiroaki, Gotoh, Kunihito, Yamada, Terumasa, Ogawa, Hisataka, Ishikawa, Osamu
• Format: Journal Article
• Language: Japanese
• Published: The Japanese Society of Gastroenterological Surgery 2011
• Subjects: indocyanine green; pancreatic body cancer; resection of celiac axis
• ISSN: 0386-9768; 1348-9372
• DOI: 10.5833/jjgs.44.721

We successfully performed stomach-preserving distal pancreatectomy with celiac axis resection sparing reconstruction of the hepatic artery for the treatment of advanced pancreatic body cancer involving the splenic and celiac artery (CeA), utilizing real-time intraoperative assessment of hepatic and gastric arterial flow with near-infrared indocyanine green (ICG) video angiography combined with intraoperative assessment of liver function using the DDG analyzer®. The patient was a 59-year-old man. Surgical exploration was performed after preoperative chemoradiation therapy for pancreatic body cancer. After pancreatic body/tail and spleen was isolated from the stomach, ICG (25mg) was administered intravenously while the CHA and CeA were clamped. The Photodynamic Eye® (PDE) clearly visualized sufficient blood flow from the superior mesenteric artery to the proper hepatic artery through an arcade of the pancreatic head and sufficient blood distribution in the whole stomach. Intraoperative assessment of liver function using the DDG analyzer® was performed simultaneously and revealed sufficient liver function while the CHA and CeA were clamped. Based on these intraoperative findings, we performed stomach-preserving pancreatectomy with en bloc celiac axis resection without reconstruction of CHA. No postoperative complications, including hepatic insufficiency and gastropathy, were observed. Real-time intraoperative assessment of hepatic and gastric arterial flow with near-infrared ICG video angiography combined with intraoperative assessment of liver function using the DDG analyzer provides objective evaluation of hepatic and gastric arterial flow while the CHA and CeA are clamped, which strongly suggests the necessity of reconstruction of the CHA and gastrectomy.