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Neoadjuvant FOLFIRINOX Followed by Pancreatoduodenectomy for Pancreatic Cancer in Patients with Previous Transhiatal Esophagectomy for Esophageal Cancer

 Juwan Kim  ;  Seung-Soo Hong  ;  Sung Hyun Kim  ;  Ho Kyoung Hwang  ;  Woo Jung Lee  ;  Jae Guen Lee  ;  Choong-Kun Lee  ;  Chang Moo Kang 
 CASE REPORTS IN ONCOLOGY, Vol.15 : 659-667, 2022-06 
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Case report ; Pancreatic cancer ; Neoadjuvant chemotherapy ; Pancreaticoduodenectomy ; Transhiatal esophagectomy
During pancreaticoduodenectomy after transhiatal esophagectomy, the preservation of the blood supply to the gastric conduit is technically difficult due to adhesion. Here, we present a case of successful pancreaticoduodenectomy after neoadjuvant chemotherapy in a patient with pancreatic head cancer who previously underwent subtotal esophagectomy with gastric reconstruction for esophageal cancer. A 69-year-old man who had undergone cholecystectomy 20 years prior and transhiatal esophagectomy 6 years prior for esophageal cancer presented to our hospital for indigestion. Computed tomography and magnetic resonance imaging revealed a 2.8-cm pancreatic head cancer, with focal abutment with the gastroduodenal artery, right gastroepiploic artery, and right colic vein. After discussion with the multidisciplinary team, the patient underwent neoadjuvant chemotherapy with six cycles of FOFIRINOX. The patient successfully underwent pancreatectomy, which preserved the pylorus. We preserved the gap between the gastric tube and the left lateral segment of the liver to avoid injuring the right gastric artery and vein. The tumor was found to be invading the gastroduodenal artery; thus, we performed R0 resection of the gastroduodenal artery and an end-to-end anastomosis between the gastroduodenal artery and the right gastroepiploic artery. After completing the surgical procedure, we added Braun anastomosis to reduce the incidence of delayed gastric emptying. Pancreaticoduodenectomy after transhiatal esophagectomy can be performed with preservation of the blood supply to the neogastric tube by reconstructing the major vessels, even in cases in which the tumor is invading or abutting the major vessels.
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1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Surgery (외과학교실) > 1. Journal Papers
Yonsei Authors
Kang, Chang Moo(강창무) ORCID logo https://orcid.org/0000-0002-5382-4658
Kim, Sung Hyun(김성현) ORCID logo https://orcid.org/0000-0001-7683-9687
Lee, Woo Jung(이우정) ORCID logo https://orcid.org/0000-0001-9273-261X
Lee, Jae Geun(이재근) ORCID logo https://orcid.org/0000-0002-6722-0257
Lee, Choong-kun(이충근) ORCID logo https://orcid.org/0000-0001-5151-5096
Hong, Seung Soo(홍승수)
Hwang, Ho Kyoung(황호경) ORCID logo https://orcid.org/0000-0003-4064-7776
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