A Case of Hepatic Arterial Resection Combined with Pancreaticoduodenectomy with Juvenile Ductal Carcinoma of the Pancreas

Kazuaki Shimada, Tsuyoshi Sano, Yoshihiro Sakamoto, Tomoo Kosuge, Minoru Sakuraba¹⁾, Nobuyoshi Hiraoka²⁾, Kouichi Itabashi³⁾ and Muneki Yoshida⁴⁾

Department of Hepatobiliary and Pancreatic Surgery and Department of Plastic Surgery¹⁾, National Cancer Center Hospital
Department of Pathology, National Cancer Center Research Institute²⁾
Department of Surgery, School of Medicine Kitasato University East³⁾
Department of Surgery, School of Medicine Kitasato University⁴⁾

A 26-year-old woman admitted with epigastralgia and duodenal bleeding was found in enhanced computed tomography (CT) to have a 50 mm low-density mass in the pancreatic head invading the duodenum, and involving the hepatic artery and portal vein. She underwent hepatic arterial resection combined with pancreaticoduodenectomy (PD) and her postoperative course was uneventful. Pathological examination showed that the tumor consisted of moderately differentiated tubular adenocarcinoma, a common type of pancreatic ductal carcinoma. Adjuvant chemotherapy using Gemcitabine was performed at the outpatient clinic, but local recurrence developed 8 months after surgery. A total radiation dosage of 50.4 Gy was used with the administration of 5-FU. Gemcitabine has been used until now and she is doing well without evidence of disease 18 months after chemoradiotherapy. Surgical resection has been considered contraindicated in patients with pancreatic cancer involving a major artery because of extremely poor survival. Our case suggests, however, that arterial resection combined with PD may be safe and effective in highly selected patients.

Key words
juvenile pancreatic cancer, hepatic arterial resection, pancreaticoduodenectomy

Reprint requests
Kazuaki Shimada Department of Hepatobiliary and Pancreatic Surgery, National Cancer Center Hospital
5-1-1 Tsukiji, Chuo-ku, 104-0045 JAPAN

Accepted
July 26, 2006

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