title: Total pancreatectomy with segmental duodenectomy preserving right gastroepiploic vein.
abstract: We performed total pancreatectomy with segmental duodenectomy preserving the gastrocolic trunk and right gastroepiploic vein, to prevent gastric venous congestion, for treatment of pancreatic tumor. This is believed to be the first report of such a procedure. The patient was a 58-year-old man with high serum levels of carbohydrate antigen 19-9 and carcinoembryonic antigen. He was examined by abdominal ultrasonography and computed tomography, and diagnosed with cancer of the pancreatic body. No distant metastasis was found. We decided to perform distal pancreatectomy. After surgery, the cut edge of the distal pancreas was subjected to frozen section examination, and there was carcinoma in situ in the stump of the main pancreatic duct. Therefore, we cut the pancreatic head partially, twice, but carcinoma in situ remained. We additionally performed pancreatic head resection with segmental duodenectomy, with preservation of the gastroduodenal artery, right gastroepiploic artery, gastrocolic trunk and right gastroepiploic vein to prevent gastric venous congestion. The postoperative course was uneventful and the patient remains in good condition. This surgical technique is considered feasible and safe for prevention of gastric venous congestion.
authors.affiliation: Department of Surgery II, Nagoya University Graduate School of Medicine, Nagoya, Japan. m-hishi@med.nagoya-u.ac.jp
authors.forename: Mitsuhiro
authors.initials: M
authors.lastname: Hishida
authors.forename: Akimasa
authors.initials: A
authors.lastname: Nakao
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Hatsuno
authors.forename: Hiromasa
authors.initials: H
authors.lastname: Yano
authors.forename: Teruyoshi
authors.initials: T
authors.lastname: Tanaka
authors.forename: Nao
authors.initials: N
authors.lastname: Takano
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Hotta
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Nakayama
authors.forename: Masato
authors.initials: M
authors.lastname: Kataoka
authors.forename: Ken
authors.initials: K
authors.lastname: Kondo
mesh_terms: D015295:Antigens, Tumor-Associated, Carbohydrate / Q000097:blood; D014408:Biomarkers, Tumor / Q000097:blood; D002272:Carcinoembryonic Antigen / Q000097:blood; D002278:Carcinoma in Situ / Q000601:surgery; D004386:Duodenum / Q000601:surgery; D005629:Frozen Sections; D006801:Humans; D008297:Male; D008875:Middle Aged; D010179:Pancreas / Q000098:blood supply*; D010180:Pancreatectomy / Q000379:methods*; D010190:Pancreatic Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D012086:Reoperation; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography
chemical_list: D015295:Antigens, Tumor-Associated, Carbohydrate; D014408:Biomarkers, Tumor; D002272:Carcinoembryonic Antigen