D'Amato Alberto, Gentili Vincenzo, Santella Sergio, Boschetto Arianna, Pronio Annamaria, Montesani Chiara
VI Clinica Chirurgica, Università degli Studi di Roma La Sapienza.
Chir Ital. 2002 Jul-Aug;54(4):539-44.
In November 1996 a 44-year-old man with an adenocarcinoma of the pancreatic head (T2 N1 Mx- UICC 1998 Stage III) underwent a Traverso-Longmire pancreaticoduodenectomy. Early reoperation was required owing to postoperative acute pancreatitis and haemorrhage of the pancreatic remnant, after which he received chemo- and radiotherapy. Twenty-nine months later, an increase in the level of CA19.9 was observed with neither clinical nor radiological evidence of cancer recurrence. Forty months later, there was evidence of a new neoplasia of the pancreatic remnant. Since the recurrence involved only the pancreatic remnant with no evidence of metastases and the patient was in good condition and enough time had elapsed since surgical eradication of the primary cancer, we decided to perform an en bloc resection of the pancreatic body and tail and the spleen. Histologically, the tumour proved to be a pancreatic adenocarcinoma (T2). It is difficult to assess whether this cancer of the pancreatic remnant was a recurrence or a second primary cancer because of the long recurrence-free survival period, the absence of neoplastic invasion of the resection margins of the two surgical specimens and the absence of multicentricity both of the portion of the gland removed by the first operation and that removed by the second.
1996年11月，一名44岁的胰头腺癌患者（T2 N1 Mx - UICC 1998年分期为III期）接受了Traverso - Longmire胰十二指肠切除术。术后因急性胰腺炎和胰腺残端出血需要早期再次手术，术后他接受了化疗和放疗。29个月后，观察到CA19.9水平升高，但无癌症复发的临床及影像学证据。40个月后，有证据表明胰腺残端出现新的肿瘤。由于复发仅累及胰腺残端，无转移证据，且患者状况良好，自手术切除原发癌后已过去足够长的时间，我们决定对胰体尾和脾脏进行整块切除。组织学检查显示，肿瘤为胰腺腺癌（T2）。由于无瘤生存期长、两个手术标本的切除边缘均无肿瘤侵犯，且首次手术和第二次手术切除的腺体部分均无多中心性，因此很难评估胰腺残端的这种癌症是复发还是第二原发癌。
