A 73-year-old man was hospitalized with pathologically documented hepatocellular carcinoma and cirrhosis, and a 5.0-cm tumor located in the left lobe was resected by a left lateral segmentectomy. At the same time, metastatic squamous cell carcinoma was identified by frozen section in a perigastric lymph node in the lesser omentum. Intraoperative endoscopy revealed a 1.0-cm erosive lesion in the thoracic esophagus that was subsequently found to be primary squamous cell carcinoma. Seven weeks later, a transthoracic subtotal esophagectomy with substernal, cervical esophagogastrostomy was performed. Twenty-two months after these resections there has been no recurrence of either the hepatocellular or esophageal carcinomas.
Abstract:We review several Japanese reports regarding pylorus-preserving pancreatoduodenectomy (PPPD), including our previous survey of a total of 313 patients who had undergone PPPD as of September, 1989 at 82 major medical facilities. PPPD in Japan was initially performed in 1981 in a patient with leiomyosarcoma of the pancreas. Because of extensive growth of the tumor, right hemicolectomy was also performed and the alimentary tract was reconstructed in the new Billroth I procedure. Many reports have since indicated that PPPD yields favorable results. The patient characteristics ranged widely, from benign diseases to malignancies, including cancer of the pancreas. The use of PPPD is how increasing both in Japan and in the United States and Europe. The operative techniques, reconstruction methods, morbidity, mortality, survival, and pathophysiology of PPPD in Japan are reviewed in comparison with these factors in the Whipple resection.
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