Case report finds indocyanine green imaging identifies insufficient gastric blood flow, implying better surgical outcomes. Aware of ischemic complications, guiding interventions can enhance recovery.
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. 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. ICG fluorescence imaging may be a useful intraoperative tool for evaluating remnant gastric perfusion during pancreatic resection following gastrectomy.
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Katayama et al. (2025) studied this question.
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