Pancreaticoduodenectomy with resection of the splenic artery and splenectomy for pancreatic double cancers after total gastrectomy. Preservation of the pancreatic function via the blood supply from the posterior epiploic artery: report of a case

Abstract

The patient was a 56-year-old man who had previously undergone a total gastrectomy without splenectomy, and was diagnosed with pancreatic head and body cancers and primary solitary lung cancer. The pancreas body tumor invaded the origin of the splenic artery, and if the origin of the splenic artery were resected there would be no blood flow to the pancreas tail, resulting in a need for total pancreatectomy. However, we focused on the posterior epiploic artery (PEA), which is a less well known blood supply from the mesocolon to pancreatic body and tail, and planned to preserve the pancreatic tail as long as the resected margin of the pancreas was not malignant, considering his limited life expectancy. We performed a pancreaticoduodenectomy with resection of the origin of the splenic artery and splenectomy, preserving the pancreatic tail and PEA. The patient has been free from insulin therapy for blood sugar control, and has been well for 10 months after the surgery.

Paradoxical impact of the remnant pancreatic volume and infectious complications on the development of nonalcoholic fatty liver disease after pancreaticoduodenectomy

“…We defined a hepatic CT value of less than 40 HU as NAFLD . Comparison of CT attenuation value between the liver and spleen was not used in this study, because the CT value of the spleen was highly influenced in the patients with resection of the splenic vein and/or artery at the time of PD .…”

A New Surgical Technique of Pancreaticoduodenectomy with Splenic Artery Resection for Ductal Adenocarcinoma of the Pancreatic Head and/or Body Invading Splenic Artery: Impact of the Balance between Surgical Radicality and QOL to Avoid Total Pancreatectomy

“…Pre- (Figure 3(c)) and postoperative MDCTs (Figure 3(d)) in PD-SAR with total gastrectomy and splenectomy demonstrate that SA and the remnant pancreas are enhanced probably via PEA. As of feeding artery for PEA, our previous report demonstrated on postoperative angiography that the middle colic artery was the source of blood supply of PEA which fed SA [6]. …”

“…Blood flow to the pancreas tail can be obtained by the left gastroepiploic artery (LGEA) and/or posterior epiploic artery (PEA) even if we have to resect the left gastric artery (LGA) combined with total gastrectomy and splenectomy [6]. Previously, proximal subtotal pancreatectomy was performed by preserving SA to maintain blood supply of the pancreatic tail [7, 8].…”

Pancreaticoduodenectomy following gastrectomy reconstructed with Billroth II or Roux-en-Y method: Case series and literature review

“…A PubMed search on May 2016 with the key words “pancreaticoduodenectomy” and “gastrectomy” revealed seven English-language reports [4], [5], [6], [7], [8], [9], [10] describing 13 cases of PD following gastrectomy reconstructed with the B-II or R-Y method. These cases are summarized in Table 2.…”