膵臓癌，直腸癌同時性重複癌に対する用手補助腹腔鏡下手術の1例

Hand-assisted laparoscopic surgery for synchronous double cancers of the pancreas and rectum : a case report

◆要旨：膵臓癌，直腸癌同時性重複癌に対し，腹腔鏡補助下手術にて切除した症例を経験したので報告する．患者は57歳,女性．50歳時ドナーとして腹腔鏡下左腎摘出術を施行されていた．CA19-9高値に対する精査にて直腸癌，膵尾部腫瘍と診断された．左腎摘出術後の癒着を考慮し，用手補助腹腔鏡下手術を行い膵体尾部切除術および低位前方切除術を施行した．術中迅速病理検査にて膵臓癌と診断されたため，膵周囲リンパ節郭清を追加した．術後6か月を経た現在，再発は認めていない．HALS併用により，左腎摘出術後の左後腹膜領域の手術操作も安全かつ容易に施行可能であった．

A-57-year-old woman who underwent left kidney resection as a donor of kidney transplantation by laparoscopic surgery was diagnosed as synchronous double cancers of the pancreas and rectum, after being tested for high level of CA19-9. We made a preoperative diagnosis of rectal cancer and pancreas tumor, and performed pancreas body-tail resection and low anterior resection by hand-assisted laparoscopic surgery（HALS） taking in account of the adhesion around the spleen. During the operation, the tumor was diagnosed as cancer of the pancreas body, so we performed lymphadenectomy. There has been no clinical sign of recurrence and the patient is alive without disease as of 6 months after the operation. We think HALS is useful and safe in difficult cases such as synchronous cancers in which operation of upper and lower abdomen is necessary.