PMC6360324_01
Scans of early-phase preoperative computed tomography with contrast medium; A: the gastroduodenal artery passing over the surface of the pancreatic head without tumor invasion; the asterisk indicates the pancreatic head cancer; B: the common bile duct and main pancreatic duct are considerably dilated.
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The tumor did not reach the surface of the pancreas and did not invade the GDA (Fig. 1).
Preoperative 3-dimensional angiography reconstructed from the computed tomography scan; the right gastroepiploic and right gastric arteries are shown supplying blood to the gastric tube.
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The patency of the RGEA, right gastroepiploic vein (RGEV), right gastric artery (RGA), and right gastric vein (RGV) were confirmed (Fig. 2, Fig. 3).
The operative view after pylorus-preserving pancreatoduodenectomy; it shows the preservation of vessels providing blood circulation to the gastric tube.. HD; hepatic duct, PV; portal vein, IVC; inferior vena cava.
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Pylorus-preserving pancreatoduodenectomy (PPPD) was then completed after dissecting the lymph nodes along the SMA (#14p, 14d), and the plexus of the pancreatic head and the right half of the SMA (Fig. 4).