Pancreaticoduodenectomy in Patients With a History of Total Gastrectomy for Stomach Cancers

Abstract

Stomach cancer is one of the most common cancers, with the highest incidence occurring in South Korea. Total gastrectomy is a not uncommon operative procedure in the majority of cases. Recent reports demonstrate improved long-term survival following gastrectomy for the treatment of stomach cancer. Improvement in overall survival following gastrectomy has meant that pancreaticoduodenectomy (PD) will be increasingly encountered in surgical practice, with a greater need to appreciate postgastrectomy anatomy. Pancreaticoduodenal resection, in the setting of a previous gastrectomy and Roux-en Y esophagojejunostomy, may present major difficulties during the assessment, resection, and reconstruction phases of the operation if the altered astrointestinal anatomy is not fully appreciated. The approach to pancreaticoduodenal resection in patients following total gastrectomy is not well described. Here we report PD in 2 patients with a history of total gastrectomy.