Pancreatic Carcinoma in the Pancreaticogastrostomy site after Pylorus-preserving Pancreatoduodenectomy for Cancer of the Papilla of Vater

Jianqiang Cai, Tatsuya Tsuji, Sugiko Watanabe, Hiroshi Takamori, Keiichiro Kanemitsu, Takehisa Hiraoka and Michio Kawasuji

First Department of Surgery, Kumamoto University School of Medicine

We report a case of pancreatic carcinoma in the pancreaticogastrostomy site after pylorus preserving pancreatoduodenectomy (PpPD). A 75-year-old woman underwent PpPD for cancer of the papilla of Vater. The pancreatic surgical margin of the PpPD specimen was free of cancer cells. Follow-up endoscopy 5 years after PpPD showed an elevated lesion at the pancreaticogastrostomy. Total resection of the remnant pancreas combined with distal gastrectomy and splenectomy were conducted under a diagnosis of pancreatic carcinoma in the remnant pancreas. Histopathological diagnosis was papillary adenocarcinoma of the pancreas (ts₄, s₀, rp_o, pv₀, a₀, t_1b, n₀, stage II) Metachronous double cancer of the papilla of Vater and the remnant pancreas curatively resected is extremely rare, and we discuss its differential diagnosis, carcinogenesis, and prognosis.

Key words
cancer of the papilla of Vater, pancreatic cancer, cancer of the remnant pancreas

Reprint requests
Tatsuya Tsuji First Department of Surgery, Kumamoto University School of Medicine 1-1-1 Honjo, Kumamoto, 860-0811 JAPAN

Accepted
November 27, 2002

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