2020 Volume 35 Issue 5 Pages 378-386
A 70-year-old man with esophageal cancer underwent subtotal esophagectomy with combined right thoracotomy and laparotomy including lymph node dissection and retrosternal gastric tube reconstruction. There was no recurrence of cancer postoperatively but he had been diagnosed with branch-type IPMN in the pancreatic head 2 years before. During follow-up, dilatation of the main pancreatic duct progressed and pointed outward with thickened enhanced cyst walls. Mural nodules were present in the branch and main pancreatic ducts. The patient was diagnosed with mixed-type IPMN (high-risk stigmata). PPPD was performed while preserving the gastroduodenal artery, right gastroepiploic artery, and right gastric artery and vein. Histopathological diagnosis revealed a mixed-type IPMN with intermediate dysplasia. The patient was discharged on postoperative day 12 without any complications. Pancreatoduodenectomy is rarely performed after radical surgery for esophageal cancer, and only 28 cases have been reported as of 2018. It is necessary to consider blood flow preservation after gastric tube reconstruction, and 3D-CTA is useful to confirm the vascular morphology and arterial anatomy. In patients after gastric tube reconstruction, right gastroepiploic artery/venous preservation is typical, but preservation and revascularization of the right gastric artery/vein should be considered when resecting.
