Is preservation of the remnant stomach safe during distal pancreatectomy in patients who have undergone distal gastrectomy?

BACKGROUND

Whether the remnant stomach can be safely preserved when performing distal pancreatectomy (DP) in patients with a prior distal gastrectomy (DG) remains unclear because the remnant stomach and pancreatic body/tail share an arterial blood supply via the splenic artery (SPA).

METHODS

A total of 18 patients with prior DG who underwent DP were enrolled in this study. Clinicopathologic data were retrospectively analyzed with a focus on management of the remnant stomach and complications related to ischemia of the remnant stomach. Additionally, intraoperative indocyanine green (ICG) fluorescence angiography was performed to visualize the blood flow and circulation in the remnant stomach.

RESULTS

Ten patients underwent a standard DP (DP in conjunction with splenectomy and division of the SPA) with preservation of the remnant stomach. The entire stomach was preserved in seven patients, and three underwent concomitant partial resection of the remnant stomach. No patients in whom the entire remnant stomach was preserved developed postoperative complications associated with it, whereas two of the three patients who underwent partial resection of the remnant stomach developed severe ischemic complications. Intraoperative ICG fluorescence angiography revealed a caudally directed circulation of blood from the esophagogastric junction through the intramural capillary network in the remnant stomach.

CONCLUSIONS

When performing DP in patients with a prior DG, preservation of the entire remnant stomach was a safe procedure because of the presence of an intramural network that supplies blood to the remnant stomach. In contrast, partial resection of the remnant stomach could be dangerous because of the potential for severe ischemic complications.

Proton pump inhibitors and histamine-2-receptor antagonists and pancreatic cancer risk: a nested case-control study

BACKGROUND

The relationship between use of proton pump inhibitors (PPIs) and histamine-2-receptor antagonists (H(2)RAs) and pancreatic cancer risk has yet to be examined. Data from a range of studies suggest biologically plausible mechanisms, whereby these drugs (or the conditions for which they are prescribed) may affect pancreatic cancer risk. The objective of this study was to investigate the relationship between use of PPIs/H(2)RAs and pancreatic cancer risk.

METHODS

A nested case-control study was conducted within the UK general practice research database (GPRD). Cases had a diagnosis of exocrine pancreatic cancer and controls were matched to cases on general practice site, sex and year of birth. Exposure to PPIs and to H(2)RAs since entry into GPRD until 2 years before the diagnosis date (corresponding date in controls) and in the 5 years before the diagnosis date were separately assessed. Conditional logistic regression analyses were used to generate odds ratios (ORs) and 95% confidence intervals (CIs) associated with PPI or H(2)RA use compared with nonuse.

RESULTS

Ever use of PPIs since entry into the GPRD (excluding the 2 years prior to diagnosis) was not associated with risk of pancreatic cancer; OR (95% CI) 1.02 (0.85-1.22). Neither the dose nor the duration of PPI or H(2)RA use was associated with pancreatic cancer risk. No consistent patterns of association were seen when cumulative exposure (dose and duration) to these drugs was examined separately or together.

CONCLUSION

PPI/H(2)RA use, in a UK population, was not associated with pancreatic cancer risk.

Billroth 1 versus Roux-en-Y reconstructions: a quality-of-life survey at 5 years

BACKGROUND

In the majority of gastric surgical units across Japan, Billroth 1 is the preferred method of anastomosis following subtotal distal gastrectomy for gastric cancer. However, across Europe and North America, reconstruction using a Roux-en-Y anastomosis is more common. There is a lack of comparative studies of the two methods focusing on long-term outcome. This study evaluated patient outcome, in terms of adverse gastrointestinal complaints and quality of life, at 5 years following surgery.

METHODS

A total of 652 patients had a subtotal distal gastrectomy for early gastric cancer between January 1993 and December 1999. We studied 229 patients with reconstruction by the Billroth 1 procedure and 214 patients with the Roux-en-Y procedure. All patients had an abdominal ultrasound and endoscopy as part of their follow-up. Quality of life was assessed by questionnaire.

RESULTS

We had an 87% response rate from the questionnaire assessment. The results demonstrated that patients were less likely to experience symptoms of either early or late dumping after Roux-en-Y anastomosis than after Billroth 1. In addition, there were significantly fewer patients with gastritis on endoscopy in the Roux-en-Y group. There was no significant difference in the average relative body weight between the groups. However, patients were more likely to develop gallstones after a Roux-en-Y than after a Billroth 1 reconstruction.

CONCLUSION

The results from this study show that, at 5 years, both symptomatically and functionally, Roux-en-Y reconstruction was superior to the Billroth I method after subtotal distal gastrectomy for gastric cancer. However, the overall outcome in both groups was good, with patient satisfaction scores of around 75% in each group.