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Pancreatoduodenectomy for distal cholangiocarcinoma 13 years after oesophagectomy with gastric tube reconstruction: report of a case
  1. Nanske C Biesma,
  2. Wouter W te Riele,
  3. Hjalmar C Van Santvoort and
  4. I Quintus Molenaar
  1. Department of Surgery, Regional Academic Cancer Center Utrecht, University Medical Center Utrecht Cancer Center & St. Antonius Hospital Nieuwegein, The Netherlands, Utrecht, The Netherlands
  1. Correspondence to Nanske C Biesma; N.C.Biesma-2{at}


Advancements in cancer management have led to improved survival in patients with oesophageal cancer. This has resulted in an increased incidence of second primary malignancies with the pancreas as a common secondary cancer site. Resectable pancreatic and periampullary cancers are treated by pancreatoduodenectomy, including resection of the gastroduodenal artery which provides the blood supply to the gastric conduit in patients who underwent oesophagectomy. A 77-year-old man with a history of distal oesophageal cancer, for which an oesophagectomy with gastric tube reconstruction was performed, presented in the emergency department. Extensive workup showed a lesion suspected for a distal cholangiocarcinoma. Pancreatoduodenectomy was deemed feasible after arterial angiography revealed that the gastric conduit was dominantly vascularised by the right gastric artery. Adequate imaging of the blood supply is essential to determine eligibility for pancreatoduodenectomy in patients with a second primary malignancy in the pancreas or periampullary region after oesophagectomy with gastric tube reconstruction.

  • gastrointestinal surgery
  • surgery
  • oesophagus
  • pancreas and biliary tract

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  • Contributors WWtR primarily led this process and initiated the development of this manuscript. HCvS and IQM provided guidance and feedback on the manuscript. The formation of the manuscript and submission was the work of NCB.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.