[A case of abdominal wall metastasis from pancreatic cancer].

A 74-year-old woman underwent laparotomy for pancreatic cancer, which revealed peritoneal dissemination. Then, gastrojejunostomy was performed. After the operation, multiple liver metastases were detected by CT scanning. However, there were no findings suggestive of peritoneal dissemination. The patient was treated with chemotherapy of gemcitabine plus S-1. At the end of five courses, the primary lesion and liver metastases decreased in size. Nevertheless, a painful hard tumor was noticed at the scar of the previous operation in the upper abdomen. Biopsy examination revealed adenocarcinoma. Accordingly, abdominal wall metastasis from pancreatic cancer was diagnosed. We speculated that the abdominal wall metastasis grew by implantation into the scar because good control of the primary lesion and liver metastasis was maintained. As no effective secondary therapy was established, chemotherapy with gemcitabine plus S-1 was continuously administered. At the end of 7 courses, the patient died of progressive peritoneal dissemination. Metastasis to the abdominal wall has been rarely reported. Moreover, the available literature contains only two reports on such metastasis from pancreatic cancer. We report herein this rare case, together with some bibliographical comments.

Clinical utility of intraductal US to decrease early recurrence rate of common bile duct stones after endoscopic papillotomy.

BACKGROUND AND AIM: The aim of the present study was to determine whether additional intraductal ultrasound (IDUS) to confirm complete stone clearance decreases the recurrence rate of common bile duct stones for a 3-year period after endoscopic papillotomy (EPT). METHODS: IDUS was carried out with a thin-caliber ultrasonic probe (diameter 2.0 mm, frequency 20 MHz) via transpapillary route after stone extraction. If IDUS showed evidence of residual stones and/or sludge, endoscopic management was performed until IDUS examination was negative. A prospective study was conducted on 59 consecutive patients undergoing additional IDUS after stone extraction between January 1996 and May 2003 (IDUS group). The recurrence rate of common bile duct stones was compared with a historical control group (August 1988 to December 1995) consisting of cases that did not undergo IDUS (non-IDUS group). Potential risk factors for recurrence of common bile duct stones were assessed by univariate and multivariate analysis on logistic regression. RESULTS: In 14 of 59 patients (23.7%), IDUS detected small residual stones not seen on cholangiography. The recurrence rate was 13.2% (17 of 129 patients) in the non-IDUS group and 3.4% (two of 59 patients) in the IDUS group (P < 0.05). Multivariate analysis subsequently identified non-IDUS status as an independent risk factor for recurrence (odds ratio 5.12, 95% CI 1.11-23.52, P = 0.036). CONCLUSIONS: Additional IDUS to confirm complete stone clearance after EPT decreases the early recurrence rate of common bile duct stones.

[Intraoperative radiotherapy (IORT) for unresectable stage IVb pancreatic cancer].

We evaluated the efficacy of IORT for unresectable Stage IVb (Japan Pancreas Society classification) pancreatic cancer. Twelve patients were treated with IORT, 17 with external beam radiotherapy (ERT) and 17 with chemotherapy (CHT, 8 patients doxorubicin-based, 7 patients 5-FU-based). Survival, hospital-free survival and pain relief were compared among the three groups. In the IORT group, 7 patients underwent bypass surgery, 3 celiac plexus blockade, 3 ERT, 2 hyperthermia and 2 CHT. In the ERT group, 1 patient underwent bypass surgery, 7 hyperthermia and 14 CHT. Distant metastases were more frequently found in the CHT group than in the IORT group. Median survival and median hospital-free survival were 208 and 79 days in the IORT group, 125 and 32 days in the ERT group and 76 and 9 days in the CHT group, respectively. Pain relief was obtained in 45% (5/11) of symptomatic patients after IORT and in 27% (4/15) after ERT. No patient (0/13) in the CHT group experienced pain relief. In conclusion, our experience suggests that IORT can reduce pain and improve QOL in patients with unresectable pancreatic cancer.