Assessment of Remnant Gastric Perfusion Using Indocyanine Green During Pancreaticoduodenectomy After Gastrectomy: A Case Report.

IF 1.7 4区医学 Q4 ONCOLOGY

Anticancer research Pub Date : 2025-09-01 DOI:10.21873/anticanres.17763

Ryo Katayama, Takeshi Aoki, Kazuhiro Matsuda, Kimiyasu Yamazaki, Yuta Enami, Akira Fujimori, Tomokazu Kusano, Ryohei Watanabe, Hiromi Date, Koji Nogaki, Yoshihiko Tashiro, Hideki Shibata, Kodai Tomioka, Takahito Hirai, Marie Uchida, Kazuhiko Saito, Tatsuya Yamazaki, Shodai Nagaishi, Yukari Shinohara, Hiroki Yamaue

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引用次数: 0

Abstract

Background/aim: Pancreatectomy after gastrectomy has been reported as a risk factor for ischemic complications in the remnant stomach. Severe complications may arise if the remnant stomach develops impaired blood flow. Herein, we describe a case of pancreaticoduodenectomy (PD) following proximal gastrectomy (PG) in which indocyanine green (ICG) fluorescence was useful for evaluating remnant gastric perfusion.

Case report: An 81-year-old woman was diagnosed with a neuroendocrine tumor (NET) of the pancreatic head 7 months after undergoing robot-assisted proximal gastrectomy (RPG) for gastric cancer. Preoperative computed tomography (CT) revealed no distant metastases or lymphadenopathy, but the tumor was close to the main pancreatic duct; therefore, PD was planned. The stomach wall was approached along the subtotal stomach-preserving pancreaticoduodenectomy (SSPPD) line. After clamping the stomach at the planned resection line, ICG was injected intravenously to evaluate perfusion. Fluorescence was observed only near the gastrojejunostomy, indicating inadequate blood flow; thus, the transection line was revised based on ICG fluorescence, and the remnant stomach was resected. Pathological findings confirmed NET, G1, pT1cN1aM0, Stage IIIB. Three months postoperatively, the patient showed no ischemia-related complications and remains under outpatient follow-up.

Conclusion: ICG fluorescence imaging may be a useful intraoperative tool for evaluating remnant gastric perfusion during pancreatic resection following gastrectomy.

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用吲哚菁绿评价胃切除术后胰十二指肠切除术中残胃灌注1例。

背景/目的：胃切除术后胰切除术已被报道为残胃缺血性并发症的危险因素。如果残胃血流受损，可能会出现严重的并发症。在此，我们描述了一例近端胃切除术（PG）后胰十二指肠切除术（PD）的病例，其中吲哚菁绿（ICG）荧光可用于评估残余胃灌注。病例报告：一名81岁女性因胃癌接受机器人辅助近端胃切除术（RPG） 7个月后被诊断为胰头神经内分泌肿瘤（NET）。术前计算机断层扫描（CT）未发现远处转移或淋巴结病变，但肿瘤靠近主胰管；因此，PD计划。胃壁沿保胃胰十二指肠大部切除术（SSPPD）线接近。在计划切除线夹紧胃后，静脉注射ICG评估灌注。荧光仅在胃空肠造口附近可见，提示血流量不足；因此，根据ICG荧光修改横切线，切除残胃。病理结果证实NET， G1, pT1cN1aM0， IIIB期。术后3个月，患者未出现缺血相关并发症，仍在门诊随访。结论：ICG荧光成像可作为评价胃切除术后胰腺切除术残胃灌注的有效工具。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Anticancer research 医学-肿瘤学

CiteScore

3.70

自引率

10.00%

发文量

566

审稿时长

2 months

期刊介绍： ANTICANCER RESEARCH is an independent international peer-reviewed journal devoted to the rapid publication of high quality original articles and reviews on all aspects of experimental and clinical oncology. Prompt evaluation of all submitted articles in confidence and rapid publication within 1-2 months of acceptance are guaranteed. ANTICANCER RESEARCH was established in 1981 and is published monthly (bimonthly until the end of 2008). Each annual volume contains twelve issues and index. Each issue may be divided into three parts (A: Reviews, B: Experimental studies, and C: Clinical and Epidemiological studies). Special issues, presenting the proceedings of meetings or groups of papers on topics of significant progress, will also be included in each volume. There is no limitation to the number of pages per issue.