[in Japanese]

View full abstract

Early detection is important in pancreatic cancer. Small pancreatic cancer less than 2 cm in diameter were analysed. A total of 21 cases, 12 males and 9 females aged between 44 and 83 (median 68.3), were resected between 1981 and 2005. 17 cases were symptomatic. The sensitivity of ERCP, MRCP and EUS were high in diagnostic imaging. More than half of cases were pT3 or pT4 and nodal involvement. Three fourth were f StageIII. Median survival time was 23.6 months and 5-year survival rate was 25.1% in all cases. R0 cases tend to survive longer than R1. Because advanced cases were often even in small pancreatic cancer, the operation with lymphadenectomy and peripancreatic tissues resection aming no residual cancer histopathologically could be needed as curative treatment.

View full abstract

Pancreatic fistula is still a troublesome complication after distal pancreatectomy. The purpose of this study was to investigate the potential of a fibrin glue containing protease inhibitor (Ulinastatin; UTI-fibrin glue) to suppress the activation of proteases released by the remnant pancreas and to prevent the occurrence of pancreatic fistula following distal pancreatectomy. Seventy-three patients who underwent distal pancreatectomy for pancreatic disease using an Proximate TL Reloadable Linear Stapler (Ethicon Endo-Surgery, LLC, Caguas, Puerto Rico 00725, USA) were studied retrospectively. There were 38 patients in the UTI-fibrin glue group and 35 in the group without UTI. UTI (10,000 U) was added to fibrin glue (3 ml), which was applied to seal the suture line of the pancreatic stump and the site of ligation of the main pancreatic duct. Post-operative pancreatic fistula occurred in five patients (13.2%) from the UTI-fibrin glue group and 13 patients (37.1%) from the non-UTI group (p<0.05). Although this was not a randomized controlled study, the result suggest the usefulness of UTI-fibrin glue for preventing postoperative fistula after distal panceatectomy.

View full abstract

A 70-year-old man admitted to the hospital because of obstructive jaundice. After an ERBD, pancreatoduodenectomy was performed with a diagnosis of carcinoma of the pancreatic head in August 2003. Histological exploration offered a diagnosis of well differentiated tubular adenocarcinoma, T4 (PV) N0, Stage IVa. 9 months after operation, an elevation of CEA and CA19-9 was noted, examinations pointed out dilatation of the MPD of remnant pancreas. After that, an elevation of tumor markers had kept up, CT scan revealed a mass in the remnant pancreas, then total remnant pancreatectomy was performed in July 2005, with a diagnosis of invasive ductal carcinoma derived from IPMT in the remnant pancreas. Histological exploration offered a diagnosis of well to moderately differentiated tubular adenocarcinoma, T4 (PL) N0, Stage IVa. Metachronous invasive ductal carcinoma of the pancreatic head and the remnant pancreas curatively resected is extremely rare.

View full abstract

A 53-year-old man had been receiving regular treatment for chronic pancreatitis. He noticed dyspnea and right chest pain. The chest X-ray indicated an accumulation of right pleural effusion along with elevated levels of amylase in the serum and pleural effusion. On the basis of CT and ERP findings, we diagnosed the patient as having an mediastinal pancreatic pseudocyst. The endoscopic pancreatic drainage (EPD) was performed, which decreased the amount of pleural effusion and the level of serum amylase. However, the inflammatory response was elevated and the cyst became enlarged in CT images. A diagnosis of infection due to EPD tube insertion was made and percutaneous cystic drainage was performed. As a result, the inflammatory response was reduced and the cyst disappeared in CT images.

View full abstract

A 77-year-old man was diagnosed as having a pancreatic cancer, and was treated by systemic gemcitabine biweekly. Though some effect of gemcitabine on the pancreatic cancer was shown by changes in the serum CA19-9 level and CT examination during the first several months, he died at 9-months. Pathological evaluation disclosed necrosis, vacuolation of carcinoma cells, phagocytosis by macrophages, and fibrosis in one third of the pancreatic tumor, consistent with the anti-tumor effect of gemcitabine. The other part of the pancreatic lesion and liver metastasis consisted of well differentiated tubular adenocarcinoma cells and necrosis which showed a resistant status to gemcitabine. In this case, we confirmed by pathological findings the effects of gemcitabine on part of the pancreatic tumor. In addition, this case shows the urgent need for second line chemotherapies and for effective therapies for metastatic liver lesions.

View full abstract

An 83-year-old man with a chief complaint of fever was transferred to our hospital. Though the patient was judged to have a carcinoma of papilla of Vater indicative for surgery, he refused operation because of his age. The patient was then suffering from obstructive jaundice and underwent endoscopic biliary drainage. Twenty one months later, endoscopic ultrasound-guided biliary drainage from the first portion of the duodenum was performed because of several incidences of stent troubles. No complications were encountered. The stent has remained patent for more than ten months.

View full abstract

A 45-years old man was admitted to our hospital because of upper abdominal pain. The patient had been diagnosed with severe acute pancreatitis induced by alcohol abuse. Abdominal computed tomography scan demonstrated a pancreatic pseudocyst with spontaneous rupture of the spleen, followed by penetration to the stomach. The infected pancreatic pseudocyst was treated by percutaneous drainage and intravenous administration of somatostatin analogue. The size of the pseudocyst decreased after the treatment, and no recurrence has been observed. Treatment with percutaneous drainage and somatostatin analogue is useful for infected pancreatic pseudocyst.

View full abstract

Gemcitabine (GEM) is widely recognized to be an effective chemotherapy for advanced pancreatic cancer. Some clinical trials of combined chemotherapy with GEM and other anti-cancer drugs have shown greater therapeutic effectiveness. We here report a case of a 63-year-old woman diagnosed with pancreatic and gastric double cancers. After systemic chemotherapy using GEM combined with S-1, the sizes of both cancers and the tumor marker levels were gradually reduced. Our case showed that GEM combined with S-1 was very useful to treat advanced pancreatic cancer and gastric cancer, and suggested a synergistic effect of the two drugs against such cancers.

View full abstract