McKeown Esophagectomy for Esophageal Cancer Following Pancreaticoduodenectomy Using a Mesenteric Approach for Pancreatic Cancer: A Case Report.
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INTRODUCTION: There are no reports of patients undergoing McKeown esophagectomy for esophageal cancer after undergoing pancreaticoduodenectomy for pancreatic cancer. We report the case of a patient who underwent subtotal esophagectomy and colon reconstruction after pancreaticoduodenectomy using the mesenteric approach. CASE PRESENTATION: A 71-year-old male was diagnosed with advanced esophageal cancer. Four years prior to diagnosis, he underwent subtotal stomach-preserving pancreaticoduodenectomy using the mesenteric approach for pancreatic surgery, followed by Child's reconstruction surgery. After undergoing 3 cycles of neoadjuvant chemotherapy with docetaxel, cisplatin, and 5-fluorouracil, the patient was scheduled for a subtotal esophagectomy. The middle colic artery was transected using the mesenteric approach, and the upper jejunum was utilized for Child's reconstruction surgery. A 2-stage procedure involving McKeown esophagectomy and left-sided colon reconstruction was planned. The 1st stage of the procedure involved robot-assisted subtotal esophagostomy in the prone position, followed by cervical esophagostomy and gastrostomy. The patient underwent the 2nd stage of the surgery after approximately 1 month of parenteral nutrition via a gastrostomy tube. The transverse colon was mobilized and transected at the hepatic flexure. The left side of the mesocolon, which is fed by the left colic artery, was then pulled up through the antethoracic route. The right internal thoracic artery and vein were anastomosed to the marginal artery and vein of the transverse colon, respectively, for supercharge and superdrainage. Reconstruction involved esophago-colonic and colonic-gastric anastomoses. The patient was discharged without postoperative complications, and no signs of recurrence were observed at the 2-year postoperative follow-up. CONCLUSIONS: Subtotal esophagectomy for esophageal cancer after subtotal stomach-preserving pancreaticoduodenectomy using a mesenteric approach and colon reconstruction can be safely performed in 2 stages. The optimization of pancreaticoduodenectomy for pancreatic cancer could improve the long-term survival of patients with 2nd primary esophageal cancer, for which radical esophagectomy is necessary.