title: [Total pancreatectomy for pancreatic head cancer accompanied with multiple lesions].
abstract: Our patient was a 67-year-old man, with a chief complaint of brown urine. He subsequently underwent medical examination in June. Because the results of his blood examination revealed liver dysfunction, he was admitted to our hospital for further careful examination. An abdominal computed tomography(CT) scan showed the presence of a pancreas tumor, with a diameter of 2 cm, at the pancreas head, as well as common biliary duct dilatation and main pancreatic duct dilation from the head to the tail of the pancreas. The patient was diagnosed with pancreatic cancer[cT3( CH+, DU+), cN0, cM0, cStage III], with obstructive jaundice. After biliary drainage, we performed laparotomy in August. During the operation, other than the tumor on the pancreas head, identified at the preoperative diagnosis, we found 2 white nodules on the pancreas surface. One nodule was located at the body of the pancreas and the other, at its tail. On intraoperative pathological examination of the nodules, they were found to be invasive ductal carcinomas. On the basis of these findings, we suspected multiple cancers or overall pancreatic cancer; therefore, we performed total pancreatectomy, not pancreaticoduodenectomy (PD). We choose pancreatectomy over PD because it was impossible to confirm the cancerous area. Pathological examination of the resected specimen did not reveal any malignant lesion. Thus, if we had not performed pancreatectomy, assuming that the pancreas body or tail had no cancer lesion, based on the pathological examination result, the cancer would have persisted. Further, careful examination involving inspection and palpation is considered to be essential before resection of the pancreas tumor.
authors.affiliation: Dept. of Surgery, Yao Municipal Hospital, Japan.
authors.forename: Reishi
authors.initials: R
authors.lastname: Toshiyama
authors.forename: Shigekazu
authors.initials: S
authors.lastname: Yokoyama
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Hashimoto
authors.forename: Mitsunobu
authors.initials: M
authors.lastname: Takeda
authors.forename: Shinji
authors.initials: S
authors.lastname: Matsumoto
authors.forename: Shuichi
authors.initials: S
authors.lastname: Fukuda
authors.forename: Atsushi
authors.initials: A
authors.lastname: Naito
authors.forename: Masayoshi
authors.initials: M
authors.lastname: Tokuoka
authors.forename: Jin
authors.initials: J
authors.lastname: Matsuyama
authors.forename: Yoshihito
authors.initials: Y
authors.lastname: Ide
authors.forename: Takashi
authors.initials: T
authors.lastname: Morimoto
authors.forename: Yukio
authors.initials: Y
authors.lastname: Fukushima
authors.forename: Takashi
authors.initials: T
authors.lastname: Nomura
authors.forename: Ken
authors.initials: K
authors.lastname: Kodama
authors.forename: Ikue
authors.initials: I
authors.lastname: Shiba
authors.forename: Masashi
authors.initials: M
authors.lastname: Takeda
authors.forename: Yo
authors.initials: Y
authors.lastname: Sasaki
mesh_terms: D000368:Aged; D000964:Antimetabolites, Antineoplastic / Q000627:therapeutic use; D003841:Deoxycytidine / Q000031:analogs & derivatives / Q000627:therapeutic use; D017809:Fatal Outcome; D006801:Humans; D007565:Jaundice / Q000209:etiology; D008297:Male; D009367:Neoplasm Staging; D010180:Pancreatectomy; D010190:Pancreatic Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000601:surgery*; D000093542:Gemcitabine
chemical_list: D000964:Antimetabolites, Antineoplastic; D003841:Deoxycytidine; D000093542:Gemcitabine