[A Useful Case of Photodynamic Diagnosis of Inferior Vena Cava Invasion by Pancreatic Head Cancer Using 5-Aminolevulinic Acid(5-ALA)].

Curative resection is necessary to survival in pancreatic cancer, however after surgery, pathologic examination sometimes diagnoses the remains of cancer at the resected stump. Therefore, it is necessary to evaluate the stump by intraoperative rapid pathological examination. 5-aminolevulinic acid(5-ALA)is an endogenous natural amino acid and precursor of the heme pathway. 5-ALA is metabolized and accumulated as protoporphyrin IX(Pp IX)that is photosensitive substance. 5-ALA mediated photodynamic diagnosis(PDD)(ALA-PDD)has high diagnostic ability. Andwe previously reportedusefulness of ALA-PDD for lymph node metastasis and peritoneal dissemination in gastric cancer and colorectal cancer patients. A case was 73-year-oldman who hadpancreatic headcancer. Since pancreatic cancer invasion to the inferior vena cava(IVC)was suspected during the operation, fluorescence observation was undergone. Pp IX fluorescence signal observedin the tissue around IVC by fluorescence observation. And, the tissue diagnosed adenocarcinoma by pathological findings. Therefore, it was judged that curative resection was difficult and the operation was completed. In conclusion, it was suggested that ALAPDD may be one of the methods of intraoperatively diagnosing the residual lesion of pancreatic cancer.