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

• Lee CM
• Yoon SY
• Park S
• Park SH

• KMID: 2466036
• DOI: http://doi.org/10.5230/jgc.2019.19.e24

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.

Reference

1. Martin RC 2nd, Jaques DP, Brennan MF, Karpeh M. Achieving RO resection for locally advanced gastric cancer: is it worth the risk of multiorgan resection? J Am Coll Surg. 2002; 194:568–577.

2. Martin RC 2nd, Jaques DP, Brennan MF, Karpeh M. Extended local resection for advanced gastric cancer: increased survival versus increased morbidity. Ann Surg. 2002; 236:159–165.

3. Jeong O, Choi WY, Park YK. Appropriate selection of patients for combined organ resection in cases of gastric carcinoma invading adjacent organs. J Surg Oncol. 2009; 100:115–120.

4. Kodama I, Takamiya H, Mizutani K, Ohta J, Aoyagi K, Kofuji K, et al. Gastrectomy with combined resection of other organs for carcinoma of the stomach with invasion to adjacent organs: clinical efficacy in a retrospective study. J Am Coll Surg. 1997; 184:16–22.

5. Shchepotin IB, Chorny VA, Nauta RJ, Shabahang M, Buras RR, Evans SR. Extended surgical resection in T4 gastric cancer. Am J Surg. 1998; 175:123–126.

6. Maehara Y, Oiwa H, Tomisaki S, Sakaguchi Y, Watanabe A, Anai H, et al. Prognosis and surgical treatment of gastric cancer invading the pancreas. Oncology. 2000; 59:1–6.

7. Chan WH, Cheow PC, Chung AY, Ong HS, Koong HN, Wong WK. Pancreaticoduodenectomy for locally advanced stomach cancer: preliminary results. ANZ J Surg. 2008; 78:767–770.

8. Roberts P, Seevaratnam R, Cardoso R, Law C, Helyer L, Coburn N. Systematic review of pancreaticoduodenectomy for locally advanced gastric cancer. Gastric Cancer. 2012; 15:Suppl 1. S108–S115.

9. Yoon JH, Kim KH, Namgoong JM, Yoon SY, Jung SW, Park YH, et al. Effectiveness of external drainage of the bile duct in pancreaticoduodenectomy: a single surgeon's experience. Korean J Hepatobiliary Pancreat Surg. 2011; 15:231–236.

10. Trede M, Schwall G, Saeger HD. Survival after pancreatoduodenectomy. 118 consecutive resections without an operative mortality. Ann Surg. 1990; 211:447–458.

11. Geer RJ, Brennan MF. Prognostic indicators for survival after resection of pancreatic adenocarcinoma. Am J Surg. 1993; 165:68–72.

12. Nitecki SS, Sarr MG, Colby TV, van Heerden JA. Long-term survival after resection for ductal adenocarcinoma of the pancreas. Is it really improving? Ann Surg. 1995; 221:59–66.

13. Yeo CJ, Abrams RA, Grochow LB, Sohn TA, Ord SE, Hruban RH, et al. Pancreaticoduodenectomy for pancreatic adenocarcinoma: postoperative adjuvant chemoradiation improves survival. A prospective, single-institution experience. Ann Surg. 1997; 225:621–633.

14. Mosca F, Giulianotti PC, Balestracci T, Di Candio G, Pietrabissa A, Sbrana F, et al. Long-term survival in pancreatic cancer: pylorus-preserving versus Whipple pancreatoduodenectomy. Surgery. 1997; 122:553–566.

15. Allema JH, Reinders ME, van Gulik TM, Koelemay MJ, Van Leeuwen DJ, de Wit LT, et al. Prognostic factors for survival after pancreaticoduodenectomy for patients with carcinoma of the pancreatic head region. Cancer. 1995; 75:2069–2076.

16. Hasson HM. A modified instrument and method for laparoscopy. Am J Obstet Gynecol. 1971; 110:886–887.

17. Shabbir A, Lee JH, Lee MS, Park DJ, Kim HH. Combined suture retraction of the falciform ligament and the left lobe of the liver during laparoscopic total gastrectomy. Surg Endosc. 2010; 24:3237–3240.

18. Japanese Gastric Cancer Association. Japanese gastric cancer treatment guidelines 2014 (ver. 4). Gastric Cancer. 2017; 20:1–19.

19. Child CG 3rd. Pancreaticojejunostomy and other problems associated with the surgical management of carcinoma involving the head of the pancreas: report of five additional cases of radical pancreaticoduodenectomy. Ann Surg. 1944; 119:845–855.

20. Lee CM, Suh YJ, Yoon SY. Retrograde installation of percutaneous transhepatic negative-pressure biliary drainage stabilizes pancreaticojejunostomy after pancreaticoduodenectomy: a retrospective cohort study. World J Surg Oncol. 2019; 17:101.

21. Washington K. 7th edition of the AJCC cancer staging manual: stomach. Ann Surg Oncol. 2010. 17:p. 3077–3079.

22. Hirose K, Onchi H, Iida A, Katayama K, Yamaguchi A, Nakagawara G. Surgical results of pancreaticoduodenectomy for carcinoma of the distal third of the stomach. Int Surg. 1999; 84:18–24.

23. Saka M, Mudan SS, Katai H, Sano T, Sasako M, Maruyama K. Pancreaticoduodenectomy for advanced gastric cancer. Gastric Cancer. 2005; 8:1–5.

24. Ajisaka H, Fujita H, Kaji M, Maeda K, Yabushita K, Konishi K, et al. Treatment of patients with gastric cancer and duodenal invasion. Int Surg. 2001; 86:9–13.

25. Wang XB, Yang LT, Zhang ZW, Guo JM, Cheng XD. Pancreaticoduodenectomy for advanced gastric cancer with pancreaticoduodenal region involvement. World J Gastroenterol. 2008; 14:3425–3429.

26. Yonemura Y, Ooyama S, Matumoto H, Kamata T, Kimura H, Takegawa S, et al. Pancreaticoduodenectomy in combination with right hemicolectomy for surgical treatment of advanced gastric carcinoma located in the lower half of the stomach. Int Surg. 1991; 76:226–229.

27. Lee HJ, Park DJ, Lee KU. Pancreaticoduodenectomy for locally advanced gastric cancer. Hepatogastroenterology. 2007; 54:977–980.

28. Menjo M, Nimura Y, Hayakawa N, Kamiya J, Kondo S, Nagino M, et al. Ten-year survival after pancreatoduodenectomy for advanced gastric cancer--report of two cases. Hepatogastroenterology. 1999; 46:1253–1256.

29. Shinohara T, Uyama I, Kanaya S, Inaba K, Isogaki J, Horiguchi A, et al. Totally laparoscopic pancreaticoduodenectomy for locally advanced gastric cancer. Langenbecks Arch Surg. 2009; 394:733–737.

30. Yoshimura F, Shinohara T, Kawamura Y, Inaba K, Ishida Y, Kanaya S, et al. Laparoscopic pancreaticoduodenectomy for locally advanced gastric cancer. Jpn J Gastroenterol Surg. 2011; 44:787–794.

31. Uyama I, Ogiwara H, Iida S, Takahara T, Furuta T, Kikuchi K. Laparoscopic minilaparotomy pancreaticoduodenectomy with lymphadenectomy using an abdominal wall-lift method. Surg Laparosc Endosc. 1996; 6:405–410.

32. Horiguchi A, Uyama I, Miyakawa S. Robot-assisted laparoscopic pancreaticoduodenectomy. J Hepatobiliary Pancreat Sci. 2011; 18:287–291.

33. Lee CM, Park DW, Park S, Kim JH, Park SH, Kim CS. Lymph node dissection using bipolar vessel-sealing device during reduced port laparoscopic distal gastrectomy for gastric cancer: result of a pilot study from a single institute. J Laparoendosc Adv Surg Tech A. 2017; 27:1101–1108.

34. Min JS, Jin SH, Park S, Kim SB, Bang HY, Lee JI. Prognosis of curatively resected pT4b gastric cancer with respect to invaded organ type. Ann Surg Oncol. 2012; 19:494–501.