Fig. 3

Surgical procedure. a Before resection. The stent was palpable, and any indication of tumor exposure to the serosa or grossly visible peritoneal metastasis. b Schema of resection line. The resection margin was set 4 cm on the oral side and 6 cm on the anal side of the stent. Lymph nodes in the region of J1A and J2A were dissected. c After resection. The J1A and J2A were transected, and the plexus of the SMA was preserved. The duodenum was dissected at the level of the 3rd portion. d Schema of reconstruction. Overlap anastomosis was performed. J1A 1st jejunal artery, J2A 2nd jejunal artery, SMA superior mesenteric artery, SMV superior mesenteric vein