Katsura Hamaguchi

Distal Pancreatectomy with En Bloc Resection of the Celiac Artery for Carcinoma of the Body and Tail of the Pancreas

SummaryConclusionCombined resection of the celiac artery with a distal pancreatectomy (DP) increases the resectability and improves the overal prognosis of patients with locally advanced ductal cancer of the body and tail of the pancreas.BackgroundCarcinoma of the body and tail of the pancreas is often unresectable because of invasion to adjacent organs. We evaluated a DP including anen bloc resection of the celiac artery (“extended”), for pancreatic cancer that had invaded the common hepatic and/or celiac arteries.MethodsSix cases of an “extended” DP were compared with 19 cases of a “standard” DP for pancreatic ductal carcinoma in terms of clinical and pathologic findings, perioperative course, and long-term outcome. We also compared the survival rate of these two groups with a third group consisting of 22 patients with unresectable pancreatic ductal carcinoma.ResultsThe mean operative time, postoperative serum aspartate aminotransferase concentration, and length of hospital stay did not significantly differ between the “extended” and “standard” DP groups. The cumulative 1- and 3-yr accumulated survival rates for the “extended,” “standard,” and unresectable groups were 40.0, 33.3, and 5.4, and 20.0, 16.6, and 0%, respectively. Statistically significant differences (p<0.01) existed between the “extended” and unresected groups.

A nonfunctioning islet cell carcinoma with tumor thrombus in both the portal and splenic veins — a case report of successful resection

A rare case of nonfunctioning islet cell carcinoma associated with tumor thrombi in both the portal and splenic veins is reported. The patient, a 49-year-old male, had a 2-year history of occasional abdominal pain. Computed tomography (CT) disclosed a huge mass in the body of the pancreas, and celiac arteriogram showed a tumor stain in the body and tail of the pancreas. Percutaneous transhepatic portography (PTP) demonstrated an irregular filling defect, indicating intraportal tumor growth. Curative surgery, which included total pancreatectomy with combined resection (50 mm in length) and reconstruction of the portal vein, distal gastrectomy, and partial resection of the transverse colon, was performed. Histological examination of the surgical specimen led to a diagnosis of nonfunctioning islet cell carcinoma with a negative immunohistochemical stain for insulin, glucagon, somatostatin, and adrenocorticotropic hormone. The patient has been well for 38 months to date without any sign of tumor recurrence. Our experience with this case has introduced a radical resection for islet cell tumor of the pancreas, even if the tumor has extended into the portal vein.

A Case of Arborecent Liver Necrosis following Continuous Arterial Infusion Chemotherapy after Resection for Liver Metastases of Alpha-Fetoprotein-producing Gastric Cancer.

症例は61歳の男性. 1998年9月30日, 肝転移を伴うAFP産生胃癌のため, 幽門側胃切除術, 肝部分切除術 (S4c+S8) を施行した. 術前の血清AFP値は5715ng/mlであった. 術後, 右肝動脈内にカテーテルを留置し, 20PODに塩酸エピルビシン20mgを動注, 引き続きフルオロウラシル (以下, 5-FU) を250mg/日, 週5日, 3週間間欠動注した. その後, 近医にて5-FUを2,500mg/週, 16回 (総量;43,750mg) 間欠持続動注を受けた. 術後9か月のCTで肝右葉のグリソンに沿った樹枝状の不染域を認めた.画像上門脈内腫瘍栓を否定できず, 肝右葉切除術を施行した. 組織学的にグリソン周囲に漏出した胆汁を伴う肝壊死であった. 本症例では5-FUの肝動脈内動注化学療法のため胆管壁内動脈の障害から胆管壊死が生じ, 胆汁漏出によるグリソン鞘炎が原因で門脈閉塞と肝壊死が生じたと考えられた. 初回手術後2年7か月の現在再発兆候なく健在である.