J Gastric Cancer.  2019 Dec;19(4):484-492. 10.5230/jgc.2019.19.e24.

Laparoscopic Whipple's Operation for Locally Advanced Gastric Cancer Invading the Pancreas and Duodenum: a Case Report

Affiliations
  • 1Department of Surgery, Korea University Medical Center, Korea University College of Medicine, Seoul, Korea. laparosamurai@gmail.com

Abstract

Few surgeons have adopted pancreaticoduodenectomy (PD) for the treatment of advanced gastric cancer (AGC) invading the pancreas or duodenum because it remains controversial whether its prognostic benefits outweigh the high morbidity rates in such advanced cases. However, recent technical advances have revived diverse surgical procedures in minimally invasive approaches. Inspired by this trend, laparoscopic PD procedures have been performed for AGC in our institute since 2014. We recently performed a laparoscopic Whipple's operation in a case of cT4b gastric cancer with invasion of the pancreatic head and duodenum.

Keyword

Gastric cancer; Laparoscopic; Pancreaticoduodenectomy

MeSH Terms

Duodenum*
Head
Pancreas*
Pancreaticoduodenectomy
Stomach Neoplasms*
Surgeons

Figure

  • Fig. 1 The procedures during lymph node dissection. (A) Ligation and division of the left gastroepiploic vessels. (B) Confirmation of the pancreas invasion. (C) Ligation and division of the left gastric vessels. (D) Division of the stomach using laparoscopic linear stapler.

  • Fig. 2 The procedures during pancreaticoduodenal resection. (A) Division of the pancreas using the ultrasonic energy device. (B) Kocher's maneuver for mobilization of the duodenum. (C) Mobilization of the proximal jejunum using the bipolar vessel-sealing device. (D) The branching vessels from the superior mesenteric vein and portal vein were meticulously dissected to separate the specimen. CHA, common hepatic artery; PV, portal vein; SMV, superior mesenteric vein; SV, splenic vein.


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