Pancreaticoduodenectomy with resection of the splenic artery and splenectomy for pancreatic double cancers after total gastrectomy. Preservation of the pancreatic function via the blood supply from the posterior epiploic artery: report of a case

The patient was a 56-year-old man who had previously undergone a total gastrectomy without splenectomy, and was diagnosed with pancreatic head and body cancers and primary solitary lung cancer. The pancreas body tumor invaded the origin of the splenic artery, and if the origin of the splenic artery were resected there would be no blood flow to the pancreas tail, resulting in a need for total pancreatectomy. However, we focused on the posterior epiploic artery (PEA), which is a less well known blood supply from the mesocolon to pancreatic body and tail, and planned to preserve the pancreatic tail as long as the resected margin of the pancreas was not malignant, considering his limited life expectancy. We performed a pancreaticoduodenectomy with resection of the origin of the splenic artery and splenectomy, preserving the pancreatic tail and PEA. The patient has been free from insulin therapy for blood sugar control, and has been well for 10 months after the surgery.