Gastric conduit-preserving, radical pancreaticoduodenectomy with microvascular reconstruction for pancreatic head cancer after esophagectomy: report of a case

Abstract

Pancreaticoduodenectomy is a radical treatment for pancreatic head cancer. However, it is sometimes difficult to perform pancreaticoduodenectomy, particularly in patients who have previously undergone esophagectomy with gastric conduit reconstruction. We herein describe a surgical technique for radical pancreaticoduodenectomy with microvascular reconstruction that preserves the gastric conduit. A 72-year-old male with a previous history of esophagectomy and gastric conduit reconstruction for esophageal cancer was referred to our hospital for surgical treatment of advanced pancreatic head cancer. After considering both the cancer curability and preservation of the gastric conduit, we performed a standard pancreaticoduodenectomy, and added a microvascular anastomosis of the gastroduodenal artery to the right gastroepiploic artery. In addition, we also performed reconstruction of the right gastroepiploic vein. This radical pancreaticoduodenectomy with microvascular reconstruction was safely and successfully performed, and it preserved the gastric conduit. The 6-month follow-up showed recurrence-free survival and a good quality of life.

Pylorus-preserving pancreatoduodenectomy for pancreatic head cancer after surgery for esophageal cancer with gastric tube reconstruction in a long-term survivor: A case report

“…With the relatively higher risk of postoperative local recurrence of pancreatic head cancer compared to other periampullary cancers, more careful consideration is required for GDA preservation. Inoue et al [ 8 ] reported that, for the pancreatic head cancer patient with suspected GDA invasion after surgery for esophageal cancer, the GDA was resected and microscopic vascular reconstruction was performed with anastomosis of the RGEA to the GDA stump and the RGEV to the left renal vein to maintain the blood circulation of the gastric tube.…”

Management and Reconstruction of a Gastroesophageal Junction Adenocarcinoma Patient Three Years after Pancreaticoduodenectomy: A Surgical Puzzle

“…Other challenging options when the right gastroepiploic vessels are compromised include the use of supercharged jejunal interposition conduits [7] or microvascular reconstruction methods for the right gastroepiploic vessels [8, 9]. Oesophagogastrectomy and pancreaticoduodenectomy are individually extensive operations, and their combination either simultaneously or metachronously poses unique challenges.…”

Creation of gastric conduit free-graft with intraoperative perfusion imaging during pancreaticoduodenectomy in a patient post esophagectomy

“…Performing a typical pancreaticoduodenectomy (PD) would require ligating the GDA, but in the setting of previous esophagectomy that would compromise the viability of the gastric conduit. Inoue et al in a recently published case report describes three different techniques previously used to overcome this technical challenge [3] . (A) PD with preservation of the GDA/GEA, (B) PD with division of the GDA/GEA and microvascular anastomosis, (C) PD with resection of the gastric conduit and reconstruction with small bowel or colon.…”

“…(A) PD with preservation of the GDA/GEA, (B) PD with division of the GDA/GEA and microvascular anastomosis, (C) PD with resection of the gastric conduit and reconstruction with small bowel or colon. Each technique has advantages and disadvantages and differ in indications, length of operation, and oncologic outcomes [3] .…”

“…Intraoperative assessment of the vascular reconstruction was performed using an intraoperative fluorescent imaging platform (SPY system; Novadaq Technologies, Inc., Mississauga, Ontario, Canada). There are less than 20 case reports outlining the resection of pancreatic tumors in patients with previous esophagectomy [3] . To our knowledge this is the first report describing this specific technique as well as the use of intraoperative perfusion imaging.…”