ito masahiro

We report a case of IPMN in which the pancreatic resection line was evaluated using simultaneous construction images of the main pancreatic duct and arteries from MD-CT. A 61-year-old male was found to have a cyst in the pancreatic body two years before. EUS confirmed a mural nodule 5.5mm in diameter in the main pancreatic duct of the pancreatic body. 3D construction images of the pancreatic arteries and the main pancreatic duct by MD-CT revealed dilatation of the main pancreatic duct where the gastroduodenal artery branches from the great pancreatic artery. After cutting the pancreatic tail at the position of the great pancreatic artery, the pancreatic parenchyma was separated cranially and resected at the portion where the gastroduodenal artery is present. Middle pancreatectomy was done. Histopathological examination revealed intraductal papillary mucinous adenoma. The tumor existed in the main pancreatic duct and had spread into the epithelium of the branches.<br>

In navigation surgery, preoperatively acquired image data are used so that surgical instruments can be guided inside the body while their location is displayed on a computer monitor. It is used in cranial nerve and spinal surgery. In the field of abdominal surgery, however, surgical manipulations in the target area cause major changes in the displayed images compared with those obtained preoperatively, and therefore, with the exception of certain organs, navigation surgery is difficult to apply. In general, this type of surgery aims to use intraoperative image information to improve surgical precision, carry out the preoperative plan accurately, and avoid dangerous areas. Three-dimensional images of the vascular architecture obtained with multislice computed tomography (MS-CT) make it possible to visualize arteries, the portal vein, bile duct, and even the pancreatic duct from any angle, which cannot be done with conventional angiography. Accurate positional relationships in the affected region can be determined preoperatively by manipulating multiplanar reconstruction images at a work station. MS-CT is extremely useful in navigation for safe performance of all types of pancreatectomy.

A 62-year-old male with hyperamylasemia was diagnosed as locally advanced pancreatic head cancer with extrapancreatic nerve plexus invasion by abdominal CT and ERCP. He underwent a course of chemoradiotherapy with a total 50Gy and systemic infusion of 600mg/m<sup>2</sup> gemcitabine(GEM) and then intravenous administration of 800mg/m<sup>2</sup> GEM was instituted after chemoradiotherapy. After 2 courses of chemotherapy, the tumor dramatically shrank and the invasion of the extra-pancreatic nerve plexuses improved. Serum CA19-9 was also decreased to standard value. The patient successfully underwent pancreatoduodenectomy with no residual tumor, and showed no sign of recurrence 18 months after first visiting our hospital. In conclusion, chemoradiotherapy followed by systemic administration of GEM was effective for unresectable pancreatic cancer, and it may allow us to curatively resect the advanced pancreatic cancer.<br>

54歳男性。患者は直腸癌に対する低位前方切除術後の経過観察中、腫瘍マーカーの上昇、CTにて膵体部腫瘍、肝腫瘍を指摘され、術後1年経過で著者らの施設へ紹介となった。入院時、腫瘍マーカーはCEA、CA19-9ともに上昇を認め、造影CTでは直腸癌の膵・肝転移と診断された。治療として膵体尾部切除術および肝部分切除術が行われた結果、病理組織学的所見は術前診断と一致し、術後8ヵ月現在、外来にて化学療法を施行中である。