When advanced gastric carcinoma is locating at upper one third, lymph nodes along the splenic artery(no. 11) and splenic hilum(no. 10) are frequently metastasized. To remove these lymph nodes, total gastrectomy wit distal pancreatectomy and
splenectomy
was necessary.
Recently, however, so called 'pancreas reserving splenectomy(PPS)' is being performed because of its known less pancreatic complications. We made a prospective study to compare pancreatic complications between several types of total gastrectomy;
①
gastrectomy only, ② gastrectomy with distal pancreatectomy and splenectomy, ③ gastrectomy with splenectomy and ④ gastrectomy with PPS. A Jackson-Pratt drain was inserted intraperitoneally during the operation to check amylase and lipase levels
postoperatively. We present the postoperative changing patterns of amount, amylase and lipase levels in the draining fluid. Serum amylase and lipase levels were also monitored. We found significantly high concentrations of amylase and lipase in
the
draining fluid within several days after total gastrectomy, especially in the pancreas preserving gastrectomy group. However, none of the patients developed pancreatic fistula, all of the surgical methods showed hyperamylasemia and
hyperlipasemia.
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