Abstract
In May 2006, a 67-year-old male who had undergone subtotal esophagectomy for thoracic esophageal cancer with gastric-tube reconstruction 5 years earlier was referred to our center for treatment of a tumor of papilla of Vater. Common bile duct dilatation and an elevated value of serum transaminase had been noted in May 2005. After precise examinations, he was diagnosed as having papillary cancer with intracholedochal spread and invasion beyond the Oddi sphincter. Therefore, pylorus preserving pancreatoduodenectomy with gastric-tube preservation was performed in July 2006. Pathological examination for resected specimen showed poorly differentiated adenocarcinoma involving the pancreatic parenchyma and lymph node metastasis (JSBS classification; pT3, pN2, M0, fStage IVa). Because the left gastric artery and left gastroepiploic vein had been divided in the previous surgery, it was essential to preserve both the gastroduodenal artery -right gastroepiploic artery and right gastroepiploic vein- gastrocolic trunk, which were the feeding and draining vessels for the gastric tube.
