Miwa Takeshi, Okumura Tomoyuki, Numata Yoshihisa, Fukasawa Mina, Kimura Nana, Watanabe Toru, Hirano Katsuhisa, Hashimoto Isaya, Shibuya Kazuto, Yoshioka Isaku, Onoda Satoshi, Satake Toshihiko, Fujii Tsutomu
Department of Surgery and Science, Faculty of Medicine, Academic Assembly, University of Toyama, Toyama, Toyama, Japan.
Department of Plastic and Reconstructive Surgery, Faculty of Medicine, Academic Assembly, University of Toyama, Toyama, Toyama, Japan.
Surg Case Rep. 2025;11(1). doi: 10.70352/scrj.cr.25-0204. Epub 2025 Sep 3.
There are no reports of patients undergoing McKeown esophagectomy for esophageal cancer after undergoing pancreaticoduodenectomy for pancreatic cancer. We report the case of a patient who underwent subtotal esophagectomy and colon reconstruction after pancreaticoduodenectomy using the mesenteric approach.
A 71-year-old male was diagnosed with advanced esophageal cancer. Four years prior to diagnosis, he underwent subtotal stomach-preserving pancreaticoduodenectomy using the mesenteric approach for pancreatic surgery, followed by Child's reconstruction surgery. After undergoing 3 cycles of neoadjuvant chemotherapy with docetaxel, cisplatin, and 5-fluorouracil, the patient was scheduled for a subtotal esophagectomy. The middle colic artery was transected using the mesenteric approach, and the upper jejunum was utilized for Child's reconstruction surgery. A 2-stage procedure involving McKeown esophagectomy and left-sided colon reconstruction was planned. The 1st stage of the procedure involved robot-assisted subtotal esophagostomy in the prone position, followed by cervical esophagostomy and gastrostomy. The patient underwent the 2nd stage of the surgery after approximately 1 month of parenteral nutrition via a gastrostomy tube. The transverse colon was mobilized and transected at the hepatic flexure. The left side of the mesocolon, which is fed by the left colic artery, was then pulled up through the antethoracic route. The right internal thoracic artery and vein were anastomosed to the marginal artery and vein of the transverse colon, respectively, for supercharge and superdrainage. Reconstruction involved esophago-colonic and colonic-gastric anastomoses. The patient was discharged without postoperative complications, and no signs of recurrence were observed at the 2-year postoperative follow-up.
Subtotal esophagectomy for esophageal cancer after subtotal stomach-preserving pancreaticoduodenectomy using a mesenteric approach and colon reconstruction can be safely performed in 2 stages. The optimization of pancreaticoduodenectomy for pancreatic cancer could improve the long-term survival of patients with 2nd primary esophageal cancer, for which radical esophagectomy is necessary.
目前尚无关于胰腺癌患者接受胰十二指肠切除术后又接受麦克基翁食管癌切除术治疗食管癌的报道。我们报告了一例采用肠系膜入路在胰十二指肠切除术后接受次全食管切除术及结肠重建术的患者。
一名71岁男性被诊断为晚期食管癌。在诊断前四年，他因胰腺手术采用肠系膜入路接受了保留部分胃的胰十二指肠切除术，随后进行了Child式重建手术。在接受多西他赛、顺铂和5-氟尿嘧啶的3个周期新辅助化疗后，该患者计划接受次全食管切除术。采用肠系膜入路切断中结肠动脉，并利用空肠上段进行Child式重建手术。计划进行两阶段手术，包括麦克基翁食管癌切除术和左侧结肠重建术。手术的第一阶段包括在俯卧位进行机器人辅助次全食管造口术，随后进行颈部食管造口术和胃造口术。在通过胃造口管进行大约1个月的肠外营养后，患者接受了手术的第二阶段。游离横结肠并在肝曲处切断。然后将由左结肠动脉供血的结肠系膜左侧通过胸前途径上提。分别将右胸廓内动脉和静脉与横结肠的边缘动脉和静脉吻合，以进行增压和引流。重建包括食管-结肠和结肠-胃吻合。患者术后无并发症出院，术后2年随访未观察到复发迹象。
采用肠系膜入路在保留部分胃的胰十二指肠切除术后行食管癌次全切除术及结肠重建术可安全地分两阶段进行。胰腺癌胰十二指肠切除术的优化可提高需要行根治性食管癌切除术的第二原发性食管癌患者的长期生存率。
