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Ischemic gastropathy after distal pancreatectomy with en bloc celiac axis resection for pancreatic body cancer

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Abstract

Purpose

Risk factors of ischemic gastropathy (IG) following distal pancreatectomy with en bloc celiac axis resection (DP-CAR) remain unclear.

Methods

Fifty consecutive patients with pancreatic cancer who underwent DP-CAR were retrospectively reviewed for possible risk factors for IG. This study was registered on the UMIN Clinical Trials Registry (UMIN 000028732).

Results

Complications higher than grade 3 were observed in 21 patients (42%) and mortality in 4 (8%). Left gastric artery (LGA) resection (P = 0.046) and a combination of left inferior phrenic artery (IPA) with LGA resection (P = 0.012) were risk factors of IG, and an elevated creatine kinase (CK) value ≥ 1005 IU/L (P = 0.025) was associated with IG. Among prognostic factors, IG (OR, 5.997; 95% CI, 1.543–23.309; P = 0.010), completion of adjuvant chemotherapy (OR, 0.282; 95% CI, 0.121–0.654; P = 0.003), longer operative time (OR, 2.261; 95% CI, 1.084–4.714; P = 0.030), and higher age (OR, 2.212; 95% CI, 1.081–4.524; P = 0.030) remained independent predictors of survival. Comparison at 2 and 3 months postoperatively showed nutritional values were higher in patients who underwent LGA-preserving DP-CAR than those with LGA-resecting DP-CAR: total protein (7.17 ± 0.56 vs 6.65 ± 0.66 g/dl, P = 0.007), albumin (4.04 ± 0.45 vs 3.43 ± 0.43 g/dl, P < 0.001), and total cholesterol (162.3 ± 34.7 vs 141.6 ± 27.2 mg/dl, P = 0.044).

Conclusions

The poorer prognosis in patients who undergo DP-CAR may be related to more advanced tumors. A combination of left IPA and LGA resection was a significant risk factor for IG. IG, completion of adjuvant chemotherapy, longer operative time, and higher age remain good independent predictors of survival.

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Acknowledgements

We would like to thank the Clinical Research Center, Wakayama Medical University, for proofreading and editing the manuscript.

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Authors and Affiliations

  1. Second Department of Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8510, Japan

    Ken-ichi Okada, Manabu Kawai, Seiko Hirono, Motoki Miyazawa, Yuji Kitahata, Masaki Ueno, Shinya Hayami & Hiroki Yamaue

  2. Clinical Study Support Center, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8510, Japan

    Toshio Shimokawa

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  1. Ken-ichi Okada
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  2. Manabu Kawai
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Contributions

KO drafted the manuscript. MK and SH helped to draft the manuscript. MM, YK, MU, and SH supported acquisition of data. HY helped in the revision of the article. TS supervised statistical analysis.

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Correspondence to Hiroki Yamaue.

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All authors declare that they have no conflict of interest.

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All procedures performed were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Okada, Ki., Kawai, M., Hirono, S. et al. Ischemic gastropathy after distal pancreatectomy with en bloc celiac axis resection for pancreatic body cancer. Langenbecks Arch Surg 403, 561–571 (2018). https://doi.org/10.1007/s00423-018-1692-z

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  • DOI: https://doi.org/10.1007/s00423-018-1692-z

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