十二指腸嵌頓をきたし膵頭十二指腸切除を要した亜有茎性進行胃癌の1症例

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  • A CASE OF INVAGINATION OF SUBPEDUNCULATED ADVANCED GASTRIC CANCER INTO THE DUODENUM, RESECTED WITH PANCREATODUODENECTOMY

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An 85-year-old man underwent laparotomy with a preoperative diagnosis of advanced gastric cancer with pyloric stenosis. However, intraoperative findings strongly suggested duodenal cancer with invasion into the stomach. While the patient was elderly, no abnormalities were found on preoperative examina-tions and curability of the operation was expected. Therefore pancreatoduodenectomy (PD) was performed. The resected specimen revealed semi-pedunculated advanced gastric cancer, which originat-ed from the pre-pylorus and completely invaginating into the 2nd portion of the duodenum. Histopathologically, the gastric cancer was classified as stage II (T2N1M0) with lymphatic invasion extending 3cm into the proper muscle layer of the duodenum. Retrospectively, the operative procedure employed was thought to be adequate from a histopathological standpoint. Generally, invasive operation should be avoided for the elderly. On the other hand, PD is now regarded as a rather safe operation so that PD can now be considered even for the elderly, provided that the operation is curative and judged safe enough.

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