Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2019 Dec 6;5(1):191.
doi: 10.1186/s40792-019-0751-1.

Pancreaticoduodenectomy following surgery for esophageal cancer with gastric tube reconstruction: a case report and literature review

Hideki Izumi  1 , Hisamichi Yoshii  2 , Rin Abe  2 , Soichiro Yamamoto  2 , Masaya Mukai  2 , Eiji Nomura  2 , Tomoko Sugiyama  3 , Takuma Tajiri  3 , Hiroyasu Makuuchi  2
Affiliations

Pancreaticoduodenectomy following surgery for esophageal cancer with gastric tube reconstruction: a case report and literature review

Hideki Izumi et al. Surg Case Rep. .

Abstract

Background: Synchronous and asynchronous multiple cancers have become more pervasive in recent years despite advances in medical technologies. However, there have been only six cases (including the present case) that underwent pancreaticoduodenectomy (PD) for pancreas head cancer following surgery for esophageal cancer. PD for treating pancreas head cancer is extremely challenging; thus, the confirmation of vessel variation and selection of surgical procedures are vital.

Case presentation: The patient was a 78-year-old Japanese male who was synchronously diagnosed with esophageal and cecal cancer 7 years previously at our hospital. He was admitted with densely stained and jaundiced urine and presented no remarkable family medical history. Following various examinations, surgery was performed due to the diagnosis of distal cholangiocarcinoma (pancreatic head cancer). Since the tumor was located far from the gastroduodenal artery (GDA) and no significant lymph node metastases could be found, subtotal stomach-preserving PD was performed instead of the resection of GDA with the right gastroepiploic artery (RGEA) for gastric tube blood flow preservation. The common hepatic artery (CHA) and GDA were confirmed, and RGEA diverged from GDA was identified. Subsequently, their respective tapings were preserved. The right gastric artery (RGA) was identified, taped, and preserved considering the gastric tube blood flow. The inflow area of the right gastroepiploic vein (RGEV) through gastric colic vein trunk in the superior mesenteric vein was exposed and preserved as the outflow of gastric tube blood flow. PD was completed without any complications on the shade of the gastric tube.

Conclusions: This case report describes successfully preserved gastric blood flow without the resection of GDA, RGEA, RGEV, or RGA. To preserve the gastric tube, GDA inflow, RGEA, RGA, and RGEV outflow should be preserved if possible. When performing PD after tube reconstruction, it is essential to confirm the relative positions of the blood vessel, blood flow, and tumor through three-dimensional computed tomography angiography before surgery and to consider the balance between the invasiveness and optimal curability of the surgery.

Keywords: 3D-CTA; Esophageal cancer; Gastric tube reconstruction; Pancreatic head cancer; Pancreaticoduodenectomy.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Ultrasonography showed a 2-cm tumor in the distal bile duct
Fig. 2
Fig. 2
Endoscopic retrograde cholangiopancreatography showed narrowing of the distal bile duct and dilation of the peripheral bile duct, and abrasion cytology was performed
Fig. 3
Fig. 3
3D-CTA revealed that the gastric tube was the feeding vessel to RGEA branching from GDA
Fig. 4
Fig. 4
The yellow arrow denotes GDA. The red arrow denotes RGEA. The blue arrow denotes the bile duct stenosis
Fig. 5
Fig. 5
Surgical view following pancreaticoduodenectomy. The image following tumor resection is shown. Arrows indicate the RGEA/V flow
See this image and copyright information in PMC

References

    1. Cameron JL, Riall TS, Coleman J, Belcher KA. One thousand consecutive pancreaticoduodenectomies. Ann Surg. 2006;244(1):10–15. doi: 10.1097/01.sla.0000217673.04165.ea. - DOI - PMC - PubMed
    1. Peters JH, Carey LC. Historical review of pancreaticoduodenectomy. Am J Surg. 1991;161:219–225. doi: 10.1016/0002-9610(91)91134-5. - DOI - PubMed
    1. Orii T, Yoshimura M, Kitahara H, Karasawa Y. Pylorus-preserving pancreatoduodenectomy for pancreatic head cancer after surgery for esophageal cancer with gastric tube reconstruction in a long-term survivor: a case report. Int J Surg Case Rep. 2019;55:92–98. doi: 10.1016/j.ijscr.2019.01.024. - DOI - PMC - PubMed
    1. Nandy N, Dasanu CA. Second primary pancreatic adenocarcinoma three years after successfully treated index esophageal cancer. JOP. 2014;15:46–48. - PubMed
    1. Fragulidis GP, Athanasopoulos PG, Melemeni A, Chondrogiannis KD, Nastos K, Koutoulidis V, Polydorou A. Pylorus-preserving pancreaticoduodenectomy after transhiatal esophagectomy sparing the right gastroepiploic vessels and gastric tube. J Gastrointest Surg. 2011;15:367–370. doi: 10.1007/s11605-010-1245-4. - DOI - PubMed

LinkOut - more resources