Abstract
Pancreatectomy remains the gold standard treatment for pancreatic malignancies but is frequently complicated by delayed gastric emptying (DGE) and gastric venous congestion (GVC). Disruption of the left gastric vein (LGV) has been increasingly implicated in these postoperative complications. We conducted a systematic review, in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines, to assess the impact of LGV preservation on post-operative complications. A comprehensive search of PubMed, MEDLINE and Google Scholar identified 205 records, 12 of which met the inclusion criteria. This comprised five case reports, two case series, two retrospective studies, one prospective imaging study, one single-centre prospective observational study and one retrospective case series. Six studies described intraoperative LGV identification via imaging or direct visualisation, while six reported complications following LGV sacrifice. Selected cases involved LGV preservation or reconstruction to mitigate adverse outcomes. Preoperative 3D-CT and MRCP facilitated surgical planning in some studies. Results showed that the LGV plays a critical role in gastric venous drainage. Its anatomical variability and inconsistent intraoperative assessment may contribute to complications. While preservation or reconstruction appears beneficial in select cases, current evidence remains limited. Further prospective, multicentre studies are essential to establish evidence-based guidelines for LGV management during pancreatectomy.