Satoshi Furukawa

Synchronous or metachronous double cancers of the pancreas and other organs: Report on 12 cases

Pancreatic carcinoma carries a poor prognosis, especially invasive ductal carcinoma of the pancreas. This retrospective study describes the results of the treatment and prognosis for double cancers in which cancer of the pancreas was associated with malignancies in other organs in 12 patients who were diagnosed and treated at Kurume University Hospital. The patients included 4 women and 8 men, with an average age of 67 years. Of the 12 tumors, 7 were metachronous pancreatic cancers which occurred after resections of other organ malignancies. Five patients had synchronous double cancers, one of whom was diagnosed to have gastric cancer on admission. Two other patients of this group were diagnosed to have lung cancer, while the remaining 2 patients suffered from colon cancer. By the time pancreatic cancer was diagnosed, gastrectomies had been performed in 7 patients for either gastric cancer or ulcers. In addition, one patient underwent a hysterectomy for uterine carcinoma and another received a low anterior resection for rectal carcinoma. Four of 5 patients in the synchronous group had nonresectable tumors and a palliative bypass operation was performed in 2 of these patients. Six patients who had metachronous double cancers died because of pancreatic cancer recurrence or metastases. We conclude that the prognosis of double cancers, where cancer of the pancreas is associated with other organ malignancies, primarily depends on the prognosis of the pancreatic carcinoma, and the present study suggests the necessity of long-term follow-up examinations for gastrectomy patients in order to make an early diagnosis of pancreatic cancer.

A Resected Case of Carcinoma of the Papilla of Vater Associated with Abnormality of the Bile Duct from the Caudate Lobe

肝外胆管走行異常は術中胆管損傷の原因として注意が必要である. 左右肝管合流部の位置より十二指腸乳頭側に位置する低位合流尾状葉胆管枝を伴う十二指腸乳頭部癌の1切除例を経験したので報告する. 症例は64歳の男性で, 黄疸にて近医受診CT, 上部消化管内視鏡検査にて乳頭部癌と診断され, 手術目的に当院入院となった. 入院時胆道造影検査にて, 総胆管より左肝管近傍へ流入する分枝を認め低位合流尾状葉胆管枝と診断. 手術は膵頭十二指腸切除を施行した. 手術所見は総胆管の左側より肝内に伸びる径2mmの尾状葉枝を認めた. 術後のCTでも尾状葉枝の拡張認めず退院となった. 異所肝管は術中損傷の原因の一つとして重要である. 2重支配を持たない異所肝管は結紮してはならないという報告や, 径2mm以上の胆管は再建の必要があると報告されている. 術前画像の詳細な検討とともに, 低位合流尾状葉胆管枝の存在にも注意が必要と考えられた.