Pylorus-Preserving Pancreaticoduodenectomy after Transhiatal Esophagectomy Sparing the Right Gastroepiploic Vessels and Gastric Tube

Abstract

This type of operation is less time-consuming and less invasive, since no further reconstruction of the alimentary tract or the vascular system is applied.

Advanced Endoscopic Rescue of a Complication (Duodenojejunostomy Leak) After a Pylorus-Preserving Pancreaticoduodenectomy in a Post-Esophagectomy Patient with Pancreatic Adenocarcinoma: A Case Report and Review of the Literature

“…10 In addition, cigar smoking, in particular, doubles the risk of UGI tract cancers. 11 Pancreatic malignancies that are localized to the head or neck of the pancreas are typically treated surgically with a pancreaticoduodenectomy (Whipple procedure), Fragulidis et al 5 A 50-year-old male with history of esophagectomy for esophageal cancer 13 years before presentation Preservation of GDA and gastroepiploic arteries Addeo et al 6 A 73-year-old male with history of right nephrectomy and lower esophagectomy 6 years before presentation Careful dissection avoiding injury to gastroepiploic vessels Kim et al 7 A 65-year-old male with concomitant esophageal and pancreatic cancers…”

“…Approximately 4% of patients develop a second UGI cancer after esophagectomy, and there are a few cases of operative management of head of pancreas cancers in post-esophagectomy patients. [4][5][6][7] These cases require complex preoperative planning and intraoperative decision making related to altered anatomy and vascular supply, as well as a heightened readiness for postoperative complications. In this article, we present a case of pancreatic adenocarcinoma managed by pylorus-preserving pancreaticoduodenectomy (PPPD) after previous esophagectomy for esophageal cancer, complicated by a duodenojejunostomy (DJ) leak.…”

Pancreaticoduodenectomy with preservation of gastric tube blood flow after esophagectomy: Report of a case

“…However, descriptions of GDA-preserving PD have previously been reported, including for pancreatic or bile duct cancers in patients who had previously undergone esophagectomy, similar to our case. 1,9–11 Prevention of lethal postoperative bleeding from the GDA stump in the presence of a pancreatic fistula was another reason for this type of surgery. 12 A third reason for selecting this technique was prevention of delayed gastric empty due to the preservation of the pyloric blood supply and innervation.…”

Gastroduodenal artery-preserving pancreaticoduodenectomy after subtotal esophagectomy and gastric pull-up

“…In the last decade, progresses achieved in the perioperative results of this operation have let to extend the indications for PD to cases previously considered as contraindicated. Nowadays, pancreatic cancer with vascular venous involvement [8], elderly patients [9], and patients with previous upper digestive surgery [10][11][12][13] are no longer considered as contraindicated if performed in tertiary referral centers for pancreatic surgery and when a radical R0 resections is reasonably expected.…”

“…Once GDA-preserving PD has been achieved, a standard reconstruction is generally performed. Several groups [10][11][12][13] prefer pancreaticojejunostomy to pancreaticogastrostomy as a pancreaticoenteric reconstruction means due to personal preferences or a theoretical increase risk of potential leaks due to gastric congestion. However, at the present no pancreaticoenteric anastomosis technique has proved to be superior and satisfactory for all patients.…”