内容紹介
Summary
Curative resection is necessary to survival in pancreatic cancer, however after surgery, pathologic examination sometimes diagnoses the remains of cancer at the resected stump. Therefore, it is necessary to evaluate the stump by intraoperative rapid pathological examination. 5-aminolevulinic acid(5-ALA)is an endogenous natural amino acid and precursor of the heme pathway. 5-ALA is metabolized and accumulated as protoporphyrin Ⅸ(Pp Ⅸ)that is photosensitive substance. 5-ALA mediated photodynamic diagnosis(PDD)(ALA-PDD)has high diagnostic ability. And we previously reported usefulness of ALA-PDD for lymph node metastasis and peritoneal dissemination in gastric cancer and colorectal cancer patients. A case was 73-year-old man who had pancreatic head cancer. Since pancreatic cancer invasion to the inferior vena cava(IVC)was suspected during the operation, fluorescence observation was undergone. Pp Ⅸ fluorescence signal observed in the tissue around IVC by fluorescence observation. And, the tissue diagnosed adenocarcinoma by pathological findings. Therefore, it was judged that curative resection was difficult and the operation was completed. In conclusion, it was suggested that ALA-PDD may be one of the methods of intraoperatively diagnosing the residual lesion of pancreatic cancer.
要旨
癌手術において癌遺残のない切除術(R0)をすることが絶対条件であるが,病理診断で切離・剝離断端が陽性と診断されるケースもある。そこで術中迅速病理検査で断端を評価する必要がある。一方,5-aminolevulinic acid(5-ALA)は代謝産物である蛍光物質のprotoporphyrin Ⅸ(Pp Ⅸ)が癌に特異的に集積する。この性質を用いて膵癌の剝離断端に対する術中診断が可能かについて検討した。症例は73歳,男性。膵頭部癌の診断で手術を施行した。術中,下大静脈(IVC)への浸潤が疑われたため剝離面を蛍光腹腔鏡で観察すると,Pp Ⅸ由来の赤い蛍光を認めたため術中迅速病理へ提出したところadenocarcinomaの診断を得た。5-ALAを用いた蛍光診断は,IVCなどの周囲組織への浸潤を認めた膵癌に対して,剝離面での癌遺残を診断できる可能性が示唆された。
目次
Curative resection is necessary to survival in pancreatic cancer, however after surgery, pathologic examination sometimes diagnoses the remains of cancer at the resected stump. Therefore, it is necessary to evaluate the stump by intraoperative rapid pathological examination. 5-aminolevulinic acid(5-ALA)is an endogenous natural amino acid and precursor of the heme pathway. 5-ALA is metabolized and accumulated as protoporphyrin Ⅸ(Pp Ⅸ)that is photosensitive substance. 5-ALA mediated photodynamic diagnosis(PDD)(ALA-PDD)has high diagnostic ability. And we previously reported usefulness of ALA-PDD for lymph node metastasis and peritoneal dissemination in gastric cancer and colorectal cancer patients. A case was 73-year-old man who had pancreatic head cancer. Since pancreatic cancer invasion to the inferior vena cava(IVC)was suspected during the operation, fluorescence observation was undergone. Pp Ⅸ fluorescence signal observed in the tissue around IVC by fluorescence observation. And, the tissue diagnosed adenocarcinoma by pathological findings. Therefore, it was judged that curative resection was difficult and the operation was completed. In conclusion, it was suggested that ALA-PDD may be one of the methods of intraoperatively diagnosing the residual lesion of pancreatic cancer.
要旨
癌手術において癌遺残のない切除術(R0)をすることが絶対条件であるが,病理診断で切離・剝離断端が陽性と診断されるケースもある。そこで術中迅速病理検査で断端を評価する必要がある。一方,5-aminolevulinic acid(5-ALA)は代謝産物である蛍光物質のprotoporphyrin Ⅸ(Pp Ⅸ)が癌に特異的に集積する。この性質を用いて膵癌の剝離断端に対する術中診断が可能かについて検討した。症例は73歳,男性。膵頭部癌の診断で手術を施行した。術中,下大静脈(IVC)への浸潤が疑われたため剝離面を蛍光腹腔鏡で観察すると,Pp Ⅸ由来の赤い蛍光を認めたため術中迅速病理へ提出したところadenocarcinomaの診断を得た。5-ALAを用いた蛍光診断は,IVCなどの周囲組織への浸潤を認めた膵癌に対して,剝離面での癌遺残を診断できる可能性が示唆された。