A Case of Duodenal Cancer treated Successfully by Gastric Tube-preserving Pancreatoduodenectomy after Esophagectomy

We present a case of duodenal cancer treated by gastric tube-preserving pancreatoduodenectomy after esophagectomy and by gastric tube reconstruction. A 77-year-old man undergoing endoscopic retrograde cholangiography for choledocholithiasis was found to have a duodenal tumor diagnosed by biopsy as well-differentiated adenocarcinoma, necessitating esophagectomy and gastric tube reconstruction for esophageal cancer 17 years earlier. To preserve the gastric tube, we conducted gastric tube-preserving pancreatoduodenectomy, skeletonizing and preserving the gastroduodenal artery and right gastroepiploic vein. The pathological diagnosis was duodenal cancer with pancreatic invasion. The postoperative course was uneventful and the man remains well with no apparent sign of recurrence 18 months after surgery. Arterial and venous gastric tube circulation should therefore be carefully preserved, on gastric tube-preserving pancreatoduodenectomy after esophagectomy.