Central pancreatic body-preserving pancreatoduodenectomy for pancreatic head cancer following a combined total gastrectomy and distal pancreatectomy: a case report

Surgical Case Reports

Toru Nakamura¹  Takehiro Noji¹  Kimitaka Tanaka¹  Toshimichi Asano¹  Yoshitsugu Nakanishi¹  Kazufumi Umemoto¹  Keisuke Okamura¹  Satoshi Hirano¹  Takahiro Tsuchikawa¹ 

[1] 0000 0001 2173 7691, grid.39158.36, Department of Gastroenterological Surgery II, Division of Surgery, Hokkaido University Faculty of Medicine, North 15, West 7, Kita-ku, 060-8638, Sapporo, Hokkaido, Japan;

关键词: Pancreas;    Pancreatic cancer;    Pancreatoduodenectomy;    Indocyanine green fluorescence;    Organ-preserving surgery;   

DOI  :  10.1186/s40792-019-0641-6

来源: publisher

【 摘 要 】

BackgroundFollowing a total pancreatectomy and a total gastrectomy procedure, patients often present with nutritional and diabetes-related disorders, along with a corresponding decrease in their quality of life. Consequently, an appropriate surgical procedure should be selected, with which an R0 resection can be achieved while conserving optimum pancreatic function, in order to prevent adverse sequelae.Case presentationWe present a case of a 66-year-old female, with a history of primary gastric cancer, for which, she underwent total gastrectomy combined with a distal pancreatectomy, 21 years ago. She presented to us with a primary cancer of the head of the pancreas. We performed a central pancreatic body-preserving pancreatoduodenectomy, in order to conserve the pancreatic function. Since the splenic artery had already been resected in the earlier surgery, conserving the blood flow to the preserved pancreatic body was an important concern. By utilizing the techniques of preoperative angiography and intraoperative indocyanine green fluorescence imaging, the pancreatic body could be accurately resected while leaving its vascular supply intact and undamaged. Thus, the patient’s pancreatic endocrine function could be preserved.ConclusionsAn accurate evaluation of the pancreatic vascular supply enabled the operating surgeon to perform a safe, central pancreatic body-preserving pancreatoduodenectomy, even in patients who have undergone a combined total gastrectomy along with a distal pancreatectomy.

【 授权许可】

CC BY