title: Gastroduodenal artery-preserving pancreaticoduodenectomy after subtotal esophagectomy and gastric pull-up.
abstract: OBJECTIVE
  Division of the gastroduodenal artery is commonly performed during pancreaticoduodenectomy for both malignant and benign disease. We describe here a technical modification of pylorus preserving pancreaticoduodenectomy with gastroduodenal artery preservation performed in a patient who previously underwent subtotal esophagectomy with gastric pull-up discussing advantages and drawbacks of the technique.
  
  
  METHODS
  A 73-year-old man with a previous history of right nephrectomy and lower esophagectomy for cancer was referred to our center for the treatment of a 5-cm tumor of the pancreatic head. Following the preliminary steps of a standard pancreaticoduodenectomy, the gastroduodenal artery was isolated at its origin from the common hepatic artery. The entire length of the gastroduodenal artery was dissected after having sectioned the posterior-superior pancreaticoduodenal artery. The right gastroepiploic vessels were preserved along with the gastroduodenal artery. Digestive reconstruction was completed just as for pylorus-preserving pancreaticoduodenectomy.
  
  
  RESULTS
  The preservation of the gastroduodenal artery along with the gastroepiloic vessels was safely performed with an operative time of 300 min and minimal blood loss. Pathology showed a solitary 5-cm renal cell carcinoma metastasis.
  
  
  CONCLUSIONS
  Gastroduodenal artery preserving pancreaticoduodenectomy can serve as an additional option in the armamentarium of a pancreatic surgeon. This technique constitutes an interesting technical option that ensures optimal vascular supply to the gastric remnant after previous esophagectomy. Its clinical application remains limited to selected indications and deserves further experience and comparison with standard techniques.
authors.affiliation: Pôle des Pathologies Digestives, Hépatiques et de la Transplantation, Hôpital de Hautepierre-Hôpitaux Universitaires de Strasbourg, 1 Avenue Moliere, 67098, Strasbourg Cedex, France.
authors.forename: Pietro
authors.initials: P
authors.lastname: Addeo
authors.forename: Ettore
authors.initials: E
authors.lastname: Marzano
authors.forename: Edoardo
authors.initials: E
authors.lastname: Rosso
authors.forename: Philippe
authors.initials: P
authors.lastname: Bachellier
authors.forename: Daniel
authors.initials: D
authors.lastname: Jaeck
authors.forename: Patrick
authors.initials: P
authors.lastname: Pessaux
mesh_terms: D001158:Arteries / Q000601:surgery; D004386:Duodenum / Q000098:blood supply*; D004938:Esophageal Neoplasms / Q000556:secondary* / Q000601:surgery; D016629:Esophagectomy / Q000379:methods*; D006801:Humans; D009378:Neoplasms, Multiple Primary / Q000601:surgery; D016577:Pancreaticoduodenectomy / Q000379:methods*; D011708:Pylorus / Q000601:surgery; D013270:Stomach / Q000098:blood supply* / Q000601:surgery*