Nachtergaele Sylvie, Mattart Laurine, Vindevogel Christophe, Francart David, Herman Dominique, Brescia Lionel
Department of Digestive Surgery, Cliniques Universitaires Saint-Luc, 1200 Bruxelles, Belgium.
Medical and Business Information, CHC Groupe Santé, 4000 Liège, Belgium.
J Surg Case Rep. 2024 Oct 13;2024(10):rjae610. doi: 10.1093/jscr/rjae610. eCollection 2024 Oct.
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.
鉴于需要保留胃成形术的血供，食管癌切除术后行胰十二指肠切除术是一项具有挑战性的手术。我们描述了一例68岁患者的改良Longmire III手术，该患者于2019年因食管腺癌接受了食管癌切除术并进行了胃管道重建。两年后，诊断为壶腹腺癌，需要行保留胃管道的胰十二指肠切除术。患者术后未出现并发症。手术切除13个月后观察到肝复发。在24个月的随访中，观察到新的肝转移。实现了胃十二指肠动脉和胃右动脉的保留，从而能够保留胃成形术。鉴于淋巴结清扫的局限性，必须始终仔细考虑该手术的适应证。在复杂手术的情况下，完整的术前检查以精确确定血管解剖结构以及任何解剖变异对于制定最佳手术策略至关重要。
