Advanced Pancreatic Cancer without Local Recurrence after Radical Pancreaticoduodenectomy with Resection of the Portal Vein and the Superior Mesenteric Artery -A Case Report with 5-year Survival

Kazuo Hoshino¹⁾, Masaya Nakamura¹⁾, Norikazu Kamoshita²⁾, Humihiro Ikeda²⁾, Yasuo Morishita²⁾ and Akio Yanagisawa³⁾

Department of Surgery, Imai Hospital¹⁾
Second Department of Surgery, Gunma University, School of Medicine²⁾
Department of Pathology, Cancer Institute³⁾

The prognosis of advanced pancreatic cancer is dismal. It is difficult to resect advanced pancreatic cancer invading the superior mesenteric artery (SMA). We report a rare case with local healing of severe advanced pancreatic cancer invading the SMA. Pancreaticoduodenectomy with resection of the portal vein (PV) and SMA was conducted in a 59-year-old woman with jaundice. CEA was 155 ng/ml and CA19-9 13,900 U/ml. Abdominal Computed Tomography (CT) and ultrasonography showed a large mass 5 cm in diameter at the pancreatic head and body invading the PV and SMA. Four-cm PV and 3-cm SMA were resected, and each was reconstructed with an end-to-end anastomosis. Blood loss was 1,785 ml. The postoperative course involved only slight diarrhea, and she was discharged 40 days after surgery. Both tumor markers decreased markedly postoperatively and she returned to regular activities 4 months postoperatively. She remained free of the disease 4 years, dying 5 years and 4 months postoperatively due to pulmonary and mediastinal metastasis of pancreatic cancer. Autopsy showed that the pancreas-intestine anastomosis, the preserved pancreas and the retroperitoneum surrounding the pancreas were intact with no cancerous lesions in the abdominal cavity.

Key words
advanced pancreatic cancer, pancreaticoduodenectomy with resection PV and SMA, 5-year survival in advanced pancreatic cancer

Reprint requests
Kazuo Hoshino Department of Surgery, Imai Hospital 100 Tanaka-cho, Ashikaga-shi, 326-0822 JAPAN

Accepted
March 26, 2003

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