title: Short- and long-term outcomes after pancreaticoduodenectomy following total gastorectomy: Report of case series and literature review.
abstract: OBJECTIVE
  Pancreaticoduodenectomy (PD) following gastrectomy (TG) should be considered challenging even currently although its procedure and clinical value have been being standardized. Short- and long-term outcomes as well as standard reconstruction method following these procedures remain unclear. In order to clarify these issues, we reviewed worldwide English literature and 4 of our own cases of PD for patients with previous TG.
  
  
  METHODS
  Clinicopathological variables of 11 cases of PD for patients with previous TG were evaluated. Seven of these 11 were abstracted from a review of worldwide English literature and 4 of 11 were our own cases.
  
  
  RESULTS
  3 cases was reconstructed using Y-limb made in previous TG and afferent loop syndrome (ALS) was observed in 2 of 3, in these cases whereas no cases of ALS were found in cases reconstructed using newly-made Y-limb. In cases where PD was indicated for cancer, early cancer death, defined as death related to cancer recurrence observed within 2 years after PD, was observed in 6 of 9 cases. Notably in cases of pancreatic cancer recurrent cancer was diagnosed within 1year after PD in 5 of 7 cases and 4 of these patients died of pancreatic cancer soon after recurrence.
  
  
  CONCLUSIONS
  In cases of PD following TG, previously-made Y-limb should not be used for reconstruction following PD because of probable cause of previously-made Y-limb for ALS. Long-term outcomes of PD after TG seemed unsatisfactory notably in cases of pancreatic cancer and thus application of PD for patients with previous TG should be carefully decided until reasonable explanation for this dismal outcome is obtained.
authors.affiliation: Department of Surgery, Japanese Red Cross Society, Wakayama Medical Center, 4-20 Komatsubara-dori, Wakayama, 640-8558, Japan. Electronic address: yokoyama.st@gmail.com.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Yokoyama
authors.affiliation: Department of Surgery, Japanese Red Cross Society, Wakayama Medical Center, 4-20 Komatsubara-dori, Wakayama, 640-8558, Japan.
authors.forename: Kohei
authors.initials: K
authors.lastname: Ueno
authors.affiliation: Department of Surgery, Japanese Red Cross Society, Wakayama Medical Center, 4-20 Komatsubara-dori, Wakayama, 640-8558, Japan.
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Higashide
authors.affiliation: Department of Surgery, Japanese Red Cross Society, Wakayama Medical Center, 4-20 Komatsubara-dori, Wakayama, 640-8558, Japan.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Noma
authors.affiliation: Department of Surgery, Japanese Red Cross Society, Wakayama Medical Center, 4-20 Komatsubara-dori, Wakayama, 640-8558, Japan.
authors.forename: Yuko
authors.initials: Y
authors.lastname: Okishio
authors.affiliation: Department of Surgery, Japanese Red Cross Society, Wakayama Medical Center, 4-20 Komatsubara-dori, Wakayama, 640-8558, Japan.
authors.forename: Mitsuru
authors.initials: M
authors.lastname: Masuda
authors.affiliation: Department of Surgery, Japanese Red Cross Society, Wakayama Medical Center, 4-20 Komatsubara-dori, Wakayama, 640-8558, Japan.
authors.forename: Takumi
authors.initials: T
authors.lastname: Miyamoto
authors.affiliation: Department of Surgery, Japanese Red Cross Society, Wakayama Medical Center, 4-20 Komatsubara-dori, Wakayama, 640-8558, Japan.
authors.forename: Ryo
authors.initials: R
authors.lastname: Kamimura
authors.affiliation: Department of Surgery, Japanese Red Cross Society, Wakayama Medical Center, 4-20 Komatsubara-dori, Wakayama, 640-8558, Japan.
authors.forename: Shinichi
authors.initials: S
authors.lastname: Hosokawa
authors.affiliation: Department of Surgery, Japanese Red Cross Society, Wakayama Medical Center, 4-20 Komatsubara-dori, Wakayama, 640-8558, Japan.
authors.forename: Yoshikuni
authors.initials: Y
authors.lastname: Yonenaga
authors.affiliation: Department of Surgery, Japanese Red Cross Society, Wakayama Medical Center, 4-20 Komatsubara-dori, Wakayama, 640-8558, Japan.
authors.forename: Daisuke
authors.initials: D
authors.lastname: Ito
authors.affiliation: Department of Surgery, Japanese Red Cross Society, Wakayama Medical Center, 4-20 Komatsubara-dori, Wakayama, 640-8558, Japan.
authors.forename: Masato
authors.initials: M
authors.lastname: Ichimiya
authors.affiliation: Department of Surgery, Japanese Red Cross Society, Wakayama Medical Center, 4-20 Komatsubara-dori, Wakayama, 640-8558, Japan.
authors.forename: Yoshito
authors.initials: Y
authors.lastname: Yamashita
authors.affiliation: Department of Surgery, Japanese Red Cross Society, Wakayama Medical Center, 4-20 Komatsubara-dori, Wakayama, 640-8558, Japan.
authors.forename: Shiro
authors.initials: S
authors.lastname: Uyama
authors.affiliation: Department of General Surgery, Faculty of Medicine, Cairo University, Al-Saray Street, El Manial, Cairo 11956, Egypt.
authors.forename: Shady EIGhazly
authors.initials: SE
authors.lastname: Harb
keywords: Afferent loop syndrome; Pancreaticoduodenectomy; Total gastrectomy