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Pancreas-contactless gastrectomy for gastric cancer prevents postoperative inflammation

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Abstract

Background

Pancreas-related complications after laparoscopic gastrectomy (LG) for gastric cancer can be fatal. We developed a gastrectomy procedure with no pancreas contact to prevent such complications and herein report the surgical outcomes.

Methods

We retrospectively reviewed 182 consecutive patients with gastric cancer who underwent LG at Kitasato University Hospital from January 2017 to January 2020. These patients were divided into a pancreas-contact group (C group) and pancreas-contactless group (CL group) for comparison of postoperative complications, and inflammatory parameters such as body temperature (BT) and C-reactive protein (CRP).

Results

Postoperative complications of CDc grade ≧ IIIa were significantly fewer in the CL group than in the C group [0/76 (0%) vs. 6/106 (5.7%), P = 0.035]. The median drain amylase (drain-AMY) on postoperative day 1 (POD1) was significantly lower in the CL group than in the C group (641 vs. 1162 IU/L, P = 0.02), as was BT at POD1 (37.4 °C vs. 37.7 °C, P = 0.04), the patient group with a BT above 37.5 °C at POD3 [5/76 (6.5%) vs. 18/106 (17%), P = 0.037], and those showing a CRP above 20.0 mg/dL at POD3 [5/76 (6.5%) vs. 20/106 (19%), P = 0.018].

Conclusions

Our technique to prevent pancreas contact during supra-pancreatic lymph node dissection during LG could minimize the inflammatory response and prevent further postoperative complications. Further large-scale, prospective studies are now required.

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Authors and Affiliations

  1. Department of Upper Gastrointestinal Surgery, Kitasato University School of Medicine, Kitasato 1-15-1, Minami-ku, Sagamihara, Kanagawa, 252-0374, Japan

    Hideki Ushiku, Mikiko Sakuraya, Marie Washio, Kei Hosoda, Masahiro Niihara, Hiroki Harada & Naoki Hiki

  2. Department of Lower Gastrointestinal Surgery, Kitasato University School of Medicine, Sagamihara, Japan

    Hirohisa Miura, Takeo Sato & Takeshi Naitoh

  3. Department of General-Pediatric-Hepatobiliary Pancreatic Surgery, Kitasato University School of Medicine, Sagamihara, Japan

    Nobuyuki Nishizawa, Hiroshi Tajima, Takashi Kaizu & Yusuke Kumamoto

  4. Department of Breast and Thyroid Surgery, Kitasato University School of Medicine, Sagamihara, Japan

    Hiroshi Kato, Norihiko Sengoku & Takafumi Sangai

  5. Division of Pediatric Surgery, Research and Development Center for New Medical Frontiers, Kitasato University School of Medicine, Sagamihara, Japan

    Kiyoshi Tanaka

  6. Division of Advanced Surgical Oncology, Research and Development Center for New Medical Frontiers, Kitasato University School of Medicine, Sagamihara, Japan

    Keishi Yamashita

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  1. Hideki Ushiku
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  2. Mikiko Sakuraya
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Correspondence to Hideki Ushiku or Naoki Hiki.

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Disclosures

Drs. Hideki Ushiku, Kei Hosoda, Masahiro Niihara, Mikiko Sakuraya, Marie Washio, Hiroki Harada, Hirohisa Miura, Hiroshi Tajima, Takashi Kaizu, Hiroshi Kato, Norihiko Sengoku, Kiyoshi Tanaka, and Keishi Yamashita have no conflicts of interest or financial ties to disclose. Dr. Takeo Sato has interests in Johnson and Johnson, Takeda Pharm, Chugai Pharm, Taiho Pharm, Lilly, Daiichi-sankyo Pharm, and Ono Pharm. Dr. Nobuyuki Nishizawa has an interest in Japan Society for the Promotion of Science. Dr. Takeshi Naitoh has interests in Japan Society for the Promotion of Science, Johnson & Johnson, Medtronic, Olympus, TERUMO, Sumitomo Bakelite, Takeda Pharm, Chugai Pharm, Merck, MC medical, Taiho Pharm, Tsumura and Co., Yakuruto Pharm, Kaken Pharm, Daiichi-sankyo Pharm, Sanofi, and Eli Lilly Japan. Dr. Yusuke Kumamoto has interests in Taiho Pharm, Kaken Pharm, Novartis Pharma, Asahi Kasei Pharm, Johnson and Johnson, Medtronic, Olympus, Japan Blood Products Organization, and TERUMO. Dr. Takafumi Sangai has interests in AstraZeneca KK, Chugai Pharma, Eisai, Kyowa Hakko Kirin, Novartis Pharma, Pfizer, Taiho Pharm, and Takeda Pharm. The authors declare no conflicts of interest regarding this study.

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Ushiku, H., Sakuraya, M., Washio, M. et al. Pancreas-contactless gastrectomy for gastric cancer prevents postoperative inflammation. Surg Endosc 36, 5644–5651 (2022). https://doi.org/10.1007/s00464-021-08961-6

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  • DOI: https://doi.org/10.1007/s00464-021-08961-6

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