内容紹介
Pancreas Bed Recurrence Resection Combined with Celiac and Common Hepatic Arterial Resection after Distal Pancreatectomy for Pancreatic Cancer
Summary
Case presentation: A 53-year-old male underwent distal pancreatectomy with splenectomy for pancreatic body cancer. An increasing mass in the soft tissue around the common hepatic artery was detected 1 year after the primary resection and he was referred to our hospital. A low density mass measuring 16 mm in length was detected around the common hepatic artery by dynamic contrast enhanced computed tomography. We diagnosed as pancreatic cancer recurrence in the pancreas bed. We performed a recurred mass resection combined with celiac and common hepatic artery resection, portal vein resection and reconstruction. Pathological examination revealed the cancer recurrence in connective tissue including nerve plexus. Adenocarcinoma cells expanded along with the nerve plexus. The tumor invaded the adventitia of the common hepatic artery. R0 resection was confirmed without exposure of cancer cells to margin. He was discharged on postoperative day 12 without any complication. He survived for 6 months after recurrence resection without metastasis. Conclusion: We experienced a case of local recurrence of pancreatic cancer successfully performed R0 resection in combination with CHA and CEA resection.
要旨
症例: 患者は53歳,男性。他院で膵体部癌に対して膵体尾部切除,脾摘術を施行された。1年後に増大する総肝動脈周囲の軟部陰影を認め,当院紹介受診となった。CTでは総肝動脈周囲に16 mm大の造影効果に乏しい腫瘍を認めた。膵癌術後膵床部再発の診断で,膵床部再発巣切除,腹腔動脈・総肝動脈合併切除,門脈合併切除再建を行った。病理学的には神経叢組織内部に高度の神経周囲浸潤を示す腺癌を認めた。総肝動脈の外膜にまで浸潤を認めたが,切除組織断端に癌の遺残は認めなかった。術後経過は良好で,12病日に退院となった。術後6か月経過した現在,無再発生存中である。結語: 膵癌外科切除後の膵床部再発に対して腹腔動脈・総肝動脈を合併切除することで,安全にR0切除を行った1例を経験した。
目次
Summary
Case presentation: A 53-year-old male underwent distal pancreatectomy with splenectomy for pancreatic body cancer. An increasing mass in the soft tissue around the common hepatic artery was detected 1 year after the primary resection and he was referred to our hospital. A low density mass measuring 16 mm in length was detected around the common hepatic artery by dynamic contrast enhanced computed tomography. We diagnosed as pancreatic cancer recurrence in the pancreas bed. We performed a recurred mass resection combined with celiac and common hepatic artery resection, portal vein resection and reconstruction. Pathological examination revealed the cancer recurrence in connective tissue including nerve plexus. Adenocarcinoma cells expanded along with the nerve plexus. The tumor invaded the adventitia of the common hepatic artery. R0 resection was confirmed without exposure of cancer cells to margin. He was discharged on postoperative day 12 without any complication. He survived for 6 months after recurrence resection without metastasis. Conclusion: We experienced a case of local recurrence of pancreatic cancer successfully performed R0 resection in combination with CHA and CEA resection.
要旨
症例: 患者は53歳,男性。他院で膵体部癌に対して膵体尾部切除,脾摘術を施行された。1年後に増大する総肝動脈周囲の軟部陰影を認め,当院紹介受診となった。CTでは総肝動脈周囲に16 mm大の造影効果に乏しい腫瘍を認めた。膵癌術後膵床部再発の診断で,膵床部再発巣切除,腹腔動脈・総肝動脈合併切除,門脈合併切除再建を行った。病理学的には神経叢組織内部に高度の神経周囲浸潤を示す腺癌を認めた。総肝動脈の外膜にまで浸潤を認めたが,切除組織断端に癌の遺残は認めなかった。術後経過は良好で,12病日に退院となった。術後6か月経過した現在,無再発生存中である。結語: 膵癌外科切除後の膵床部再発に対して腹腔動脈・総肝動脈を合併切除することで,安全にR0切除を行った1例を経験した。