膵内副脾に発生したepidermoid cyst を伴う直腸癌に対し腹腔鏡下超低位前方切除と用手補助腹腔鏡下尾側膵切除を一期的に施行した1例

A ６５-year-old man with bleeding on defecation was referred to our hospital. Screening colonoscopy revealed a type２rectal cancer（tub１）in Rb. Furthermore, CT scan revealed a２cm in diameter tumor in the tail of the pancreas. Laboratory test showed no increase of tumor markers. PET-CT revealed rectal wall thickness and lymph node swelling（＃２５１）with increased FDG uptake, but no FDG uptake by pancreas tumor. Dynamic MRI revealed no enhancement of cystic tumor of the pancreas. We performed laparoscopic super low anterior resection, D３（bilateral lymph node dissection）and hand-assisted laparoscopic distal pancreatectomy at the same time. Pathological findings demonstrated rectal cancer with lymph node metastasis and an epidermoid cyst derived from an intrapancreatic accessory spleen. Laparoscopic surgery for distant more than one tumor was a feasible and less invasive treatment.