Pancreatic Compression during Lymph Node Dissection in Laparoscopic Gastrectomy: Possible Cause of Pancreatic Leakage

Satoshi Ida; Naoki Hiki; Takeaki Ishizawa; Yugo Kuriki; Mako Kamiya; Yasuteru Urano; Takuro Nakamura; Yasuo Tsuda; Yosuke Kano; Koshi Kumagai; Souya Nunobe; Manabu Ohashi; Takeshi Sano

doi:https://doi.org/10.5230/jgc.2018.18.e15

추천

검색

자료유형: 학술저널

저자정보: Satoshi Ida (Cancer Institute Hospital of the Japanese Foundation for Cancer Research) Naoki Hiki (Cancer Institute Hospital of the Japanese Foundation for Cancer Research) Takeaki Ishizawa (Cancer Institute Hospital of the Japanese Foundation for Cancer Research) Yugo Kuriki (The University of Tokyo) Mako Kamiya (The University of Tokyo) Yasuteru Urano (The University of Tokyo) Takuro Nakamura (Japanese Foundation for Cancer Research) Yasuo Tsuda (Cancer Institute Hospital of the Japanese Foundation for Cancer Research) Yosuke Kano (Cancer Institute Hospital of the Japanese Foundation for Cancer Research) Koshi Kumagai (Cancer Institute Hospital of the Japanese Foundation for Cancer Research) Souya Nunobe (Cancer Institute Hospital of the Japanese Foundation for Cancer Research) Manabu Ohashi (Cancer Institute Hospital of the Japanese Foundation for Cancer Research) Takeshi Sano (Cancer Institute Hospital of the Japanese Foundation for Cancer Research)

저널정보: 대한위암학회 Journal of Gastric Cancer Journal of Gastric Cancer 제18권 제2호

발행연도: 2018.6

수록면: 134 - 141 (8page)

DOI: https://doi.org/10.5230/jgc.2018.18.e15

이용수

📌

연구주제

📖

연구배경

🔬

연구방법

🏆

연구결과

초록· 키워드

오류제보하기

Purpose: Postoperative pancreatic fistula is a serious and fatal complication of gastrectomy for gastric cancer. Blunt trauma to the parenchyma of the pancreas can result from an assistant's forceps compressing and retracting the pancreas, which in turn may result in pancreatic juice leakage. However, no published studies have focused on blunt trauma to the pancreas during laparoscopic surgery. Our aim was to investigate the relationship between compression of the pancreas and pancreatic juice leakage in a swine model. Materials and Methods: Three female pigs were used in this study. The pancreas was gently compressed dorsally for 15 minutes laparoscopically with gauze grasped with forceps. Pancreatic juice leakage was visualized by fluorescence imaging after topical administration of chymotrypsin-activatable fluorophore in real time. Amylase concentrations in ascites collected at specified times was measured. In addition, pancreatic tissue was fixed with formalin, and the histology of the compressed sites was evaluated. Results: Fluorescence imaging enabled visualization of pancreatic juice leaking into ascites around the pancreas. Median concentrations of pancreatic amylase in ascites increased from 46 U/L preoperatively to 12,509 U/L 4 hours after compression. Histological examination of tissues obtained 4 hours after compression revealed necrotic pancreatic acinar cells extending from the surface to deep within the pancreas and infiltration of inflammatory cells. Conclusions: Pancreatic compression by the assistant's forceps can contribute to pancreatic juice leakage. These findings will help to improve the procedure for lymph node dissection around the pancreas during laparoscopic gastrectomy.

#Blunt injury #Laparoscopy #Optical imaging #Pancreatic juice #Swine

참고문헌 (20)

참고문헌 신청

Hosono S / 2006 / Meta-analysis of short-term outcomes after laparoscopy-assisted distal gastrectomy / World J Gastroenterol 12:7676~7683

Vinuela EF / 2012 / Laparoscopic versus open distal gastrectomy for gastric cancer: a meta-analysis of randomized controlled trials and high-quality nonrandomized studies / Ann Surg 255:446~456

Yakoub D / 2009 / Laparoscopic assisted distal gastrectomy for early gastric cancer: is it an alternative to the open approach? / Surg Oncol 18:322~333

Zeng YK / 2012 / Laparoscopy-assisted versus open distal gastrectomy for early gastric cancer: evidence from randomized and nonrandomized clinical trials / Ann Surg 256:39~52

Irino T / 2016 / The Hit and Away technique: optimal usage of the ultrasonic scalpel in laparoscopic gastrectomy / Surg Endosc 30:245~250

함께 읽어보면 좋을 논문

논문 유사도에 따라 DBpia 가 추천하는 논문입니다. 함께 보면 좋을 연관 논문을 확인해보세요!

이 논문의 저자 정보

Satoshi Ida

소속기관 Department of Gastroenterological Surgery Gastroenterological Center Cancer Institute Hospital Japanese Foundation for Cancer Research Tokyo Japan