Right gastro-omental artery reconstruction after pancreaticoduodenectomy for subtotal esophagectomy and gastric pull-up

Okochi, Masayuki; Sakaba, Takao; Kenjo, Akira; Gotoh, Mitsukazu

doi:10.1016/j.ijscr.2015.08.020

Cited by 15 publications

(11 citation statements)

References 14 publications

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“…We chose MCA to reconstruct the RGEA, because we mainly use MCA to reconstruct left gastric arteries during distal pancreatectomy with celiac axis resection to preserve blood flow of the stomach, and we are experienced in the procedure [35]. Reconstruction of the RGEA using MCA has also been reported by Okochi et al [31]. ICGfluorescence imaging is helpful to confirm blood flow in the remnant stomach [36].…”

Section: Discussionmentioning

confidence: 99%

“…There have been several reports of successful pancreaticoduodenectomy associated with esophagectomy (Table 1) [15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34]. The RGEA can be preserved in patients with non-pancreatic ductal adenocarcinoma; however, in two cases, it has been described as difficult [30,31]. Inoue et al reported radical pancreaticoduodenectomy with microvascular anastomosis of the cut end of the GDA and RGEA to secure the arterial blood flow of the gastric conduit [30].…”

Section: Discussionmentioning

confidence: 99%

“…There have been several reports of successful pancreaticoduodenectomy associated with esophagectomy (Table 1 ) [ 15 – 34 ]. The RGEA can be preserved in patients with non-pancreatic ductal adenocarcinoma; however, in two cases, it has been described as difficult [ 30 , 31 ]. Inoue et al .…”

Section: Discussionmentioning

confidence: 99%

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Pancreaticoduodenectomy with reconstructing blood flow of the gastric conduit after esophagectomy with concomitant celiac axis stenosis: a case report

et al. 2020

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Background Pancreaticoduodenectomy after esophageal resection is technically difficult, because blood flow of the gastric conduit should be preserved. Celiac axis stenosis (CAS) is also a problem for pancreaticoduodenectomy, because arterial blood supply for the liver comes mainly through the collateral route from the superior mesenteric artery (SMA) via the gastroduodenal artery (GDA). Herein, we report the case of a patient with pancreatic head cancer who underwent a pancreaticoduodenectomy after esophagectomy with concomitant CAS. Case presentation A 76-year-old man with pancreatic head cancer was referred to our department. He had a history of esophagectomy with retrosternal gastric conduit reconstruction for esophageal cancer. Computed tomography showed severe CAS and a dilated collateral route between the SMA and the splenic artery (SPA). We prepared several surgical options depending on the intraoperative findings, and performed radical pancreaticoduodenectomy with concomitant resection of the distal gastric conduit. The right gastroepiploic artery (RGEA) of the remnant gastric conduit was fed from the left middle colic artery (MCA) with microvascular anastomosis. Despite CAS, when the GDA was dissected and clamped, good blood flow was confirmed, and the proper hepatic artery did not require reconstruction. The patient was discharged on postoperative day 90. Conclusions We successfully performed radical pancreaticoduodenectomy after esophagectomy with concomitant CAS, having prepared multiple surgical options depending upon the intraoperative findings.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Pancreaticoduodenectomy with reconstructing blood flow of the gastric conduit after esophagectomy with concomitant celiac axis stenosis: a case report

et al. 2020

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“… [ 8 ] Okochi et al 2015 70 M PHC Metachoronous 5 RGEA 8m, alive RGEA, resected and reconstructed to R. branch of MCA. [ 9 ] Nagano et al 2005 55 M PVC Metachoronous 17 RCA, MCA, MCV Not described Post-DG, esophagectomy with TG. Colonic interposition.…”

Section: Discussionmentioning

confidence: 99%

“…Okochi et al [ 9 ] also reported that they successfully anastomosed the cut end of the RGEA to the right branch of the middle colic artery (MCA) microscopically after RGEA resection because the pancreatic head cancer was adjacent to the vessel.…”

Section: Discussionmentioning

confidence: 99%

Pylorus-preserving pancreatoduodenectomy for pancreatic head cancer after surgery for esophageal cancer with gastric tube reconstruction in a long-term survivor: A case report

Orii

Yoshimura

Kitahara

et al. 2019

International Journal of Surgery Case Reports

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Distal Pancreatectomy with Celiac Axis Resection Combined with Reconstruction of the Left Gastric Artery

Sato

Inoue

Takahashi

et al. 2017

Journal of Gastrointestinal Surgery

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Distal pancreatectomy with celiac axis resection is one of the most aggressive approaches for the treatment of locally advanced pancreatic cancer with common hepatic artery and/or celiac axis invasion. However, ischemic complications such as ischemic gastropathy and liver failure are problematic. To avoid these complications, we developed left gastric artery-reconstructing distal pancreatectomy with celiac axis resection. We used the middle colic artery for reconstruction. We performed this procedure in 10 patients, using the middle colic artery in three different ways: left branch reconstruction, right branch reconstruction, and reverse reconstruction. On postoperative images, 90% of the reconstructed left gastric arteries were patent. No complications associated with arterial reconstruction occurred. No patients developed ischemic gastropathy or liver failure. The R0 resection rate was 70%. Nine patients underwent adjuvant chemotherapy and seven patients were able to start it within 90 days. Distal pancreatectomy with celiac axis resection combined with reconstruction of the left gastric artery using the middle colic artery is a feasible option and would enhance the safety for carefully selected patients. Multicenter validation is needed to clarify the benefits of this new procedure.

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Right gastro-omental artery reconstruction after pancreaticoduodenectomy for subtotal esophagectomy and gastric pull-up

Cited by 15 publications

References 14 publications

Pancreaticoduodenectomy with reconstructing blood flow of the gastric conduit after esophagectomy with concomitant celiac axis stenosis: a case report

Pancreaticoduodenectomy with reconstructing blood flow of the gastric conduit after esophagectomy with concomitant celiac axis stenosis: a case report

Pylorus-preserving pancreatoduodenectomy for pancreatic head cancer after surgery for esophageal cancer with gastric tube reconstruction in a long-term survivor: A case report

Distal Pancreatectomy with Celiac Axis Resection Combined with Reconstruction of the Left Gastric Artery

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