A Pancreatoduodenectomy for Common Bile Duct Cancer after Coronary Artery Bypass Using the Right Gastroepiploic Artery

Ito, Yoshitomo; Fukunaga, Masaki; Shimada, Masahiko; Hirasaki, Yoshinori; Azuma, Daisuke

doi:10.5833/jjgs.2014.0086

Cited by 2 publications

(2 citation statements)

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“…In other words, considering the resectability of the tumor during PD, GDA and RGEA must be preserved or reconstructed. There are 13 articles (including 5 Japanese articles) [26][27][28][29][30][31][32][33][34][35][36][37][38] that discuss PD after CABG using RGEA (Table 2). There were 16 patients in total including our case, and one of them was female, with a mean age of 70 years.…”

Section: Discussionmentioning

confidence: 99%

“…However, a CABG using RGEA in a patient with rare anatomical aberrant GDA should not be considered as an obstacle when R0 resection is achievable. 2019 Homsy et al [26] 73 M Pancreatic cancer PD Yes Intraoperative rerouting to GDA None None 2018 CreTu et al [22] 70 [23] 73 M Ampullary cancer PPPD No None Pseudoaneurysm of RGEA None 2015 Ito et al [24] 63 M Bile duct cancer PD No Preoperative PCI to RCA None None 2014 Kitamura et al [25] 67 M Bile duct cancer SSPPD No None None None 2014 Fukuhara et al [26] 66 F Ampullary cancer PPPD No None None None 2014 Fujikawa et al [27] 64 M Pancreatic cancer SSPPD Yes Preoperative PCI to RCA None None 2013 Turcanu et al [28] 71 M Pancreatic cancer PD No None None None 2011 Takami et al [29] 80 M Bile duct cancer SSPPD No None None None 2011 Nakamura et al [30] 69 M Ampullary cancer PD Yes Intraoperative rerouting (graft unspecified)…”

Section: Discussionmentioning

confidence: 99%

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Pancreaticoduodenectomy preserving aberrant gastroduodenal artery utilized in a previous coronary artery bypass grafting

et al. 2021

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Rationale: Pancreaticoduodenectomy (PD) is a technically demanding procedure with high rates of morbidity and mortality. Therefore, preoperative evaluation of anatomy is indispensable. Multi-detector row computed tomography (CT) enables us to precisely understand arterial anatomy. It is a well-known fact that anatomical variants are often present in the hepatic artery (HA) but rarely in the gastroduodenal artery (GDA). We present the case of a patient with ampullary cancer with a rare anatomical anomaly, “replaced GDA (rGDA) ” arising from the superior mesenteric artery, along with a history of coronary artery bypass grafting (CABG) using right gastroepiploic artery (RGEA). Patient concerns: A 69-year-old male patient was referred to our department for further investigation of elevated hepatobiliary enzymes. He presented with no symptoms besides intermittent fever of 38°C. He had an operative history of CABG using the RGEA. Diagnosis: Abdominal CT and esophagogastroduodenoscopy showed an ampullary tumor and biopsy specimen from the lesion revealed adenocarcinoma. CT angiography revealed the rGDA instead of a normal common HA. Intervention: We performed a safe PD, preserving the rGDA and the RGEA to maintain hepatic and cardiac perfusion. Outcomes: Owing to the presence of a refractory pancreatic fistula, the length-of-hospital stay was extended, and he was discharged on postoperative day 72 without vascular complications. At present, the patient is in good physical condition and does not present with cardiovascular complications as well as tumor recurrence at 6 months after surgery. Lessons: This is possibly the first case of a patient who underwent PD and has a proper HA following a GDA arising from a superior mesenteric artery (rGDA) and has a previous operative history of CABG using the gastroepiploic artery. The coexistence of the history of cardiovascular surgery made PD for this patient considerably more challenging. In the case of a rare anatomical anomaly, a coronary artery bypass via the RGEA should not be considered as an obstacle when R0 resection is achievable.

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