A Case Report of Pancreatic Cancer with Two Pancreatic Resections after Coronary Artery Bypass Grafting Using the Right Gastroepiploic Artery

Abstract

The patient was a 75-year-old man who underwent second coronary artery bypass grafting (CABG) using the right gastroepiploic artery (RGEA). At the age of 70 years, he had undergone distal pancreatectomy for intraductal papillary mucinous adenocarcinoma. A diagnosis of distal cholangiocarcinoma was made during a thorough examination for recurrent cholangitis. Pancreaticoduodenectomy was planned, but coronary angiography showed that the graft was patent, the surgery was performed with the possibility of revascularization in mind, and it was possible to preserve the RGEA without damaging it. The patient had undergone distal pancreatectomy and consequently underwent a total pancreatectomy. Histopathological findings showed invasive pancreatic ductal carcinoma, pT3N1b, stage IIB, and R0 resection was possible. Upper abdominal surgery after CABG with an RGEA graft requires careful technique, because damage to the RGEA may cause cardiac complications. In addition, graft reconstruction may be required if the graft is damaged or if the graft needs to be resected for dissection. In addition to intraoperative support of the graft, adequate preparation and measures for adhesions and revascularization are essential.