Utility of Laparoscopic Distal Pancreatectomy Following Esophagectomy With Gastric Roll Reconstruction Through the Retrosternal Route.

Background: Esophagectomy with gastric roll reconstruction through the retrosternal route can result in significant anatomical shifts in the pancreatic head and neck. These shifts must be carefully considered when planning distal pancreatectomy (DP) after esophagectomy.

Methods: We analyzed 15 patients who underwent CT scans after discharge following esophagectomy with gastric roll reconstruction via the retrosternal route. Using CT images, we examined the anatomical features necessary to safely perform DP after esophagectomy.

Results: The horizontal distances from the vertebral body to the superior mesenteric vein (SMV), superior mesenteric artery (SMA), and gastroduodenal artery (GDA) post-esophagectomy were 12.0, 21.7, and - 4.0 mm, respectively, indicating significant leftward shifts compared with preoperative measurements (SMV: 2.7 mm, p = 0.023; SMA: 9.2 mm, p = 0.046; GDA: -17.5 mm, p < 0.001). The angles between the horizontal line through the center of the SMA and the line connecting the SMA to the SMV (34.5°) and GDA (34.7°) were wider compared with the preoperative SMV (18.4°, p = 0.050) and GDA (17.9°, p = 0.018). Based on sagittal CT sections, the distance between the caudal edge of the gastric roll and the xiphoid process was 100.7 mm. We present a case of laparoscopic DP for pancreatic tail cancer after esophagectomy with gastric roll reconstruction via the retrosternal route.

Conclusions: The altered vascular positioning and the presence of the gastric roll make minimally invasive approaches, particularly laparoscopic DP, advantageous, as they reduce the risk of damaging the gastric roll and the right gastroepiploic artery (RGEA).