Sato Yuta, Tanaka Yoshihiro, Hatanaka Yuji, Horaguchi Takeshi, Fukada Masahiro, Yasufuku Itaru, Asai Ryuichi, Tajima Jesse Yu, Murase Katsutoshi, Matsuhashi Nobuhisa
Department of Gastroenterological Surgery and Pediatric Surgery, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu City, Gifu Prefecture, 501-1194, Japan.
Clin J Gastroenterol. 2025 Apr;18(2):249-257. doi: 10.1007/s12328-025-02093-3. Epub 2025 Jan 14.
Complex surgery during initial cancer treatment can limit surgical options when planning management of a secondary malignancy. Subtotal esophagectomy and pancreatoduodenectomy are the most invasive and difficult procedures in gastroenterological surgery. Surgical cases in which subtotal esophagectomy was performed after pancreatoduodenectomy with pancreaticogastrostomy are extremely rare and challenging procedures due to the resulting complicated anatomical changes.
A 60-year-old man with a history of conversion pancreatoduodenectomy with pancreaticogastrostomy for advanced pancreatic head cancer was diagnosed as having advanced thoracic esophageal squamous cell carcinoma. After neoadjuvant chemotherapy, we chose a two-staged surgery with thoracoscopic subtotal esophagectomy. Following percutaneous endoscopic gastrostomy, we performed subtotal esophagectomy, systematic lymph-node dissection, and esophagostomy as the first-stage operation. Fifty-six days later, we performed gastrointestinal reconstruction with pedicle jejunum and microvascular anastomosis by the percutaneous route as the second-stage operation. Postoperatively, the patient was relieved without major complications, and the tumors were amenable to curative pathologic resection.
The greatest advantages of staged surgery are to reduce surgical invasiveness and to circumvent the lower rate of curability. Our procedure reported here may be recommended as an option for staged resection and reconstruction in patients with advanced esophageal cancer after pancreatoduodenectomy with pancreaticogastrostomy.
初次癌症治疗期间的复杂手术可能会限制在计划二次恶性肿瘤治疗时的手术选择。食管次全切除术和胰十二指肠切除术是胃肠外科中最具侵入性且难度最大的手术。在胰十二指肠切除术后行胰胃吻合术再进行食管次全切除术的手术病例极为罕见，且由于由此产生的复杂解剖变化，该手术极具挑战性。
一名60岁男性，有因晚期胰头癌行胰十二指肠切除术后改做胰胃吻合术的病史，被诊断为晚期胸段食管鳞状细胞癌。新辅助化疗后，我们选择了两阶段手术，即胸腔镜食管次全切除术。在经皮内镜下胃造口术后，我们进行了食管次全切除术、系统性淋巴结清扫和食管造口术作为第一阶段手术。56天后，我们通过经皮途径进行了带蒂空肠微血管吻合的胃肠道重建作为第二阶段手术。术后，患者症状缓解，无重大并发症，肿瘤可进行根治性病理切除。
分期手术的最大优点是降低手术侵袭性并规避较低的治愈率。我们在此报告的手术方法可作为胰十二指肠切除术后行胰胃吻合术的晚期食管癌患者分期切除和重建的一种选择。
