Gastric Tube-preserving Pylorus-preserving Pancreatoduodenectomy 5 Years after Esophagectomy for Ampullary Carcinoma

Abstract

A 72-year-old woman developed obstructive jaundice, and we diagnosed ampullary carcinoma. She had undergone esophagectomy by right thoracotomy and laparotomy, with cervical, thoracic, and abdominal lymphadenectomy, with reconstruction using gastric tube through posterior intrathoracic route for esophageal cancer at the age of 67. The alignment of the major related vessels was confirmed by 3D-CT-angiography preoperatively. Gastric tube-preserving pylorus-preserving pancreatoduodenectomy (PPPD) was planned for the patient. PPPD-IIA-1 was performed with preservation of right gastroepiploic artery (RGEA), right gastroepiploic vein (RGEV), and right gastric artery (RGA). The post-operative course was good. A gastric tube for reconstruction after esophagectomy may require blood supply mainly by RGEA and RGA. Sacrifice of those vessels might lead to necrosis of the gastric tube. There are 16 domestic case reports, including the present case, of pancreatoduodenectomy (PD) after esophagectomy. RGEA was preserved in all cases except for one. RGEV was preserved in 10 cases. An appropriate procedure of PD after esophagectomy should be chosen in terms of surgical radicality and surgical stress. The authors describe a rare case of gastric tube preserving PD.