2 Long Term Survival Cases of Small Pancreatic Cancers Performed Middle Pancreatectomy

Kosuke Tobita, Toshihide Imaizumi, Yasuo Ohtani, Masanori Ishii, Hiroyuki Kashiwagi, Shoichi Dowaki, Yoshinori Sugio, Takafumi Sekka, Hiroshi Kijima* and Hiroyasu Makuuchi

Department of Surgery, Pathology*, Tokai University, School of Medicine

We conducted middle pancreatectomy in 2 patients who had small pancreatic cancer measuring 1 cm in diameter. Case 1: A 72-year-old woman seen for epigastralgia was found in ultrasonic examination to have a tumor on the pancreatic body. Further examination led to a diagnosis of small pancreatic cancer, necessitating middle pancreatectomy. The pathological diagnosis was moderately differentiated tubular adenocarcinoma type stage I. The patient remains alive without recurrence 5 years and 7 months after surgery. Case 2: A 68-year-old man with a dilated pancreatic duct and a pancreatic body tumor which were detected ultrasonically during routine screening was found on. further examinations to have a small cancer on the pancreatic body, for which the patient underwent middle pancreatectomy. The pathological diagnosis was moderately differentiated tubular adenocarcinoma stage IV a. The patient remains free of recurrence 5 years and 3 months after surgery. Extended surgery is generally indicated even when the tumor diameter is relatively small because of the high incidence of vascular invasion and metastasis. In addition to morphological diagnosis, we evaluated the expression of thrombospondin-1 and epidermal growth factor receptor as molecular markers associated with cancer invasion and metastasis. We suggest these molecular markers point to the possibility of nonextended operation in pancreatic cancer with low-grade metastatic potential.

Key words
small pancreatic cancer, middle pancreatectomy, 5-year survival

Reprint requests
Kosuke Tobita Department of Surgery, Tokai University, School of Medicine
Bohseidai, Isehara, 259-1193 JAPAN

Accepted
April 28, 2004

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