Gastric Tube-preserving Pancreaticoduodenectomy for Ampullary Adenocarcinoma After Lewis-Santy Esophagectomy: a Case Report and Literature Review

Overview

Journal J Surg Case Rep

Publisher Oxford University Press

Specialty General Surgery

Date 2024 Oct 15

PMID 39403672

Authors

Sylvie Nachtergaele

Laurine Mattart

Christophe Vindevogel

David Francart

Dominique Herman

Lionel Brescia

Affiliations

Soon will be listed here.

Abstract

Pancreaticoduodenectomy after esophagectomy is a challenging procedure given the need to preserve the vascularization of the gastric plasty. We describe a case of a modified Longmire III procedure in a 68-year-old patient who underwent an esophagectomy with gastric conduit reconstruction in 2019 for esophageal adenocarcinoma. Two years later, an adenocarcinoma of the ampulla of Vater was diagnosed, necessitating pancreaticoduodenectomy with preservation of the gastric conduit. The patient presented no postoperative complications. Hepatic recurrence was observed 13 months after surgical resection. At 24 months follow-up, new liver metastases were observed. Preservation of the gastroduodenal and right gastric arteries was achieved, enabling conservation of the gastric plasty. Given the limitations of lymphadenectomy, the indication for this surgery must always be carefully considered. In the context of complex surgery, a complete preoperative workup to precisely determine the vascular anatomy as well as any anatomical variations is essential to establish the best operative strategy.

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