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Surgery Today

, Volume 44, Issue 7, pp 1313–1320 | Cite as

Pancreatic cancer in the remnant pancreas following primary pancreatic resection

  • Daisuke Hashimoto
  • Akira Chikamoto
  • Masaki Ohmuraya
  • Kazuya Sakata
  • Keisuke Miyake
  • Hideyuki Kuroki
  • Masayuki Watanabe
  • Toru Beppu
  • Masahiko Hirota
  • Hideo BabaEmail author
Original Article

Abstract

Purpose

To clarify the clinical features of cancer in the pancreatic remnant.

Methods

We retrospectively reviewed the clinical and pathological findings of 10 patients who developed remnant pancreatic cancer in our hospital between 2002 and 2012. The KRAS sequences in both the initial pancreatic tumor and remnant pancreatic cancer were examined in two patients.

Results

Eight patients underwent a second pancreatectomy for remnant pancreatic cancer (resected group), while two patients were not operated on and underwent chemotherapy (unresected group). The remnant pancreatic cancer developed at the cut end of the pancreas (pancreaticogastrostomy site) in four patients. In the resected group, four patients died 17 months after the emergence of the remnant pancreatic cancer and four patients survived during the median 40.5-month observation period. The median survival of the unresected group after the emergence of the remnant pancreatic cancer was 10 months. The findings of the KRAS sequencing and immunohistological staining of the remnant pancreatic cancer for MUC1 and MUC2 in the two patients were consistent with those of the initial pancreatic tumor in one patient, and not consistent in the other.

Conclusions

Our results suggest that both local recurrence and a new primary cancer can develop in the pancreatic remnant, and repeated pancreatectomy can prolong survival.

Keywords

Pancreatic cancer Local recurrence Operation 

Notes

Conflict of interest

The authors declare that they have no conflicts of interest.

References

  1. 1.
    DeOliveira M, Winter J, Schafer M, Cunningham S, Cameron J, Yeo C, et al. Assessment of complications after pancreatic surgery a novel grading system applied to 633 patients undergoing pancreaticoduodenectomy. Ann Surg. 2006;244:931–9.PubMedCentralPubMedCrossRefGoogle Scholar
  2. 2.
    Hashimoto D, Takamori H, Sakamoto Y, Ikuta Y, Nakahara O, Furuhashi S, et al. Is Estimation of physiologic ability and surgical stress (E-PASS) able to predict operative morbidity after pancreaticoduodenectomy? J Hepatobiliary Pancreat Surg. 2010;17:132–8.CrossRefGoogle Scholar
  3. 3.
    Hashimoto D, Takamori H, Sakamoto Y, Tanaka H, Hirota M, Baba H. Can the Estimation of Physiologic Ability and SurgicalStress (E-PASS) scoring system predict operative morbidity after distal pancreatectomy? Surg Today. 2010;40:632–7.PubMedCrossRefGoogle Scholar
  4. 4.
    Lin JW, Cameron JL, Yeo CJ, Riall TS, Lillemoe KD. Risk factors and outcomes in postpancreaticoduodenectomy pancreaticocutaneous fistula. J Gastrointest Surg. 2004;8:951–9.PubMedCrossRefGoogle Scholar
  5. 5.
    Hawkins WG, Alseidi A. DISPACT trial: what do we learn from equivalency? Lancet. 2011;377:1470–1.PubMedCrossRefGoogle Scholar
  6. 6.
    Motoi F, Egawa S, Rikiyama T, Katayose Y, Unno M. Randomized clinical trial of external stent drainage of the pancreatic duct to reduce postoperative pancreatic fistula after pancreaticojejunostomy. Br J Surg. 2012;99:524–31.PubMedCrossRefGoogle Scholar
  7. 7.
    Yamada S, Shimada M, Utsunomiya T, Morine Y, Imura S, Ikemoto T, et al. Surgical results of pancreatoduodenectomy in elderly patients. Surg Today. 2012;42:857–62.PubMedCrossRefGoogle Scholar
  8. 8.
    Garcea G, Dennison AR, Pattenden CJ, Neal CP, Sutton CD, Berry DP. Survival following curative resection for pancreatic ductal adenocarcinoma. A systematic review of the literature. JOP. 2008;9:99–132.PubMedGoogle Scholar
  9. 9.
    Smeenk HG, Incrocci L, Kazemier G, van Dekken H, Tran KT, Jeekel J, et al. Adjuvant 5-FU-based chemoradiotherapy for patients undergoing R-1/R-2 resections for pancreatic cancer. Dig Surg. 2005;22:321–8.PubMedCrossRefGoogle Scholar
  10. 10.
    Smeenk HG, Tran TC, Erdmann J, van Eijck CH, Jeekel J. Survival after surgical management of pancreatic adenocarcinoma: does curative and radical surgery truly exist? Langenbecks Arch Surg. 2005;390:94–103.PubMedCrossRefGoogle Scholar
  11. 11.
    Westerdahl J, Andrén-Sandberg A, Ihse I. Recurrence of exocrine pancreatic cancer—local or hepatic? Hepatogastroenterology. 1993;40:384–7.PubMedGoogle Scholar
  12. 12.
    Inoue K, Kosuge T, Shimada K, Yamamoto J, Takayama T, Ozaki H, et al. Repeated radical resection and intraoperative irradiation for recurrent pancreatic ductal adenocarcinoma after pancreatoduodenectomy. Surgery. 1995;118:909–11.PubMedCrossRefGoogle Scholar
  13. 13.
    Kleeff J, Reiser C, Hinz U, Bachmann J, Debus J, Jaeger D, et al. Surgery for recurrent pancreatic ductal adenocarcinoma. Ann Surg. 2007;245:566–72.PubMedCentralPubMedCrossRefGoogle Scholar
  14. 14.
    Miura F, Takada T, Amano H, Yoshida M, Isaka T, Toyota N, et al. Repeated pancreatectomy after pancreatoduodenectomy. J Gastrointest Surg. 2007;11:179–86.PubMedCrossRefGoogle Scholar
  15. 15.
    Cheng Q, Zhang B, Zhang Y, Jiang X, Zhang B, Yi B, et al. Predictive factors for complications after pancreaticoduodenectomy. J Surg Res. 2007;139:22–9.PubMedCrossRefGoogle Scholar
  16. 16.
    House M, Fong Y, Arnaoutakis D, Sharma R, Winston C, Protic M, et al. Preoperative predictors for complications after pancreaticoduodenectomy: impact of BMI and body fat distribution. J Gastrointest Surg. 2008;12:270–8.PubMedCrossRefGoogle Scholar
  17. 17.
    Japan Pancreas Society General rules for the study of pancreatic cancer (the 6th edition) April 2009.Google Scholar
  18. 18.
    Japanese society of biliary surgery Society General rules for surgical and pathological studies on cancer of the biliary tract (the 5th edition) September 2003.Google Scholar
  19. 19.
    Bardeesy N, DePinho R. Pancreatic cancer biology and genetics. Nat Rev Cancer. 2002;2:897–909.PubMedCrossRefGoogle Scholar
  20. 20.
    Hruban RH, van Mansfeld AD, Offerhaus GJ, van Weering DH, Allison DC, Goodman SN, et al. K-ras oncogene activation in adenocarcinoma of the human pancreas. A study of 82 carcinomas using a combination of mutant-enriched polymerase chain reaction analysis and allele-specific oligonucleotide hybridization. Am J Pathol. 1993;143:545–54.PubMedCentralPubMedGoogle Scholar
  21. 21.
    Almoguera C, Shibata D, Forrester K, Martin J, Arnheim N, Perucho M. Most human carcinomas of the exocrine pancreas contain mutant c-K-ras genes. Cell. 1988;53:549–54.PubMedCrossRefGoogle Scholar
  22. 22.
    Zhang C, Guo W, Wu J, Song B, Zhang C, Dai Q, et al. Differential high-resolution melting analysis for the detection of K-ras codons 12 and 13 mutations in pancreatic cancer. Pancreas. 2011;40:1283–8.PubMedCrossRefGoogle Scholar
  23. 23.
    Capella G, Cronauer-Mitra S, Pienado MA, Perucho M. Frequency and spectrum of mutations at codons 12 and 13 of the c-K-ras gene in human tumors. Environ Health Perspect. 1991;93:125–31.PubMedCentralPubMedCrossRefGoogle Scholar
  24. 24.
    Shigaki H, Baba Y, Watanabe M, Miyake K, Murata A, Iwagami S et al.KRAS and BRAF mutations in 203 esophageal squamous cell carcinomas: Pyrosequencing technology and literature review. Ann Surg Oncol. doi: 10.1245/s10434-012-2819-z 2012 Dec 30. [Epub ahead of print].
  25. 25.
    Ogino S, Kawasaki T, Brahmandam M, Yan L, Cantor M, Namgyal C, et al. Sensitive sequencing method for KRAS mutation detection by Pyrosequencing. J Mol Diagn. 2005;7:413–21.PubMedCentralPubMedCrossRefGoogle Scholar
  26. 26.
    Shen S, Qin D. Pyrosequencing data analysis software: a useful tool for EGFR, KRAS, and BRAF mutation analysis. Diagn Pathol. 2012;7:56.PubMedCentralPubMedCrossRefGoogle Scholar
  27. 27.
    Kobayashi T, Sato Y, Hirukawa H, Soeno M, Shimoda T, Matsuoka H, et al. Total pancreatectomy combined with partial pancreas autotransplantation for recurrent pancreatic cancer: a case report. Transplant Proc. 2012;44:1176–9.PubMedCrossRefGoogle Scholar
  28. 28.
    Kim C, Tono T, Kimura Y, Watanabe A, Nakamura H, Inadome J, et al. Re-resection for local recurrence in the remnant pancreas after pancreaticoduodenectomy for pancreatic cancer- a case report. Gan To Kagaku Ryoho. 2011;38:2448–50.PubMedGoogle Scholar
  29. 29.
    Ioka T, Ikeda M, Ohkawa S, Yanagimoto H, Fukutomi A, Sugimori K, et al. Randomized phase III study of gemcitabine plus S-1 (GS) versus S-1 versus gemcitabine (GEM) in unresectable advanced pancreatic cancer (PC) in Japan and Taiwan: GEST study. J Clin Oncol. 2011;29(suppl):4007.Google Scholar
  30. 30.
    Ohashi Y, Tanaka M, Boku N, Ueno H, Okusaka T. Quality of life (QOL) evaluation within a randomized phase III study of gemcitabine plus S-1 (GS) versus S-1 versus gemcitabine (GEM) in unresectable, advanced pancreatic cancer (PC) in Japan and Taiwan: GEST study. J Clin Oncol. 2011;29(suppl):9070.Google Scholar
  31. 31.
    Yang SH, Dou KF, Sharma N, Song WJ. The methods of reconstruction of pancreatic digestive continuity after pancreaticoduodenectomy: a meta-analysis of randomized controlled trials. World J Surg. 2011;35:2290–7.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Japan 2013

Authors and Affiliations

  • Daisuke Hashimoto
    • 1
  • Akira Chikamoto
    • 1
  • Masaki Ohmuraya
    • 2
  • Kazuya Sakata
    • 1
  • Keisuke Miyake
    • 1
  • Hideyuki Kuroki
    • 1
  • Masayuki Watanabe
    • 1
  • Toru Beppu
    • 1
  • Masahiko Hirota
    • 3
  • Hideo Baba
    • 1
    Email author
  1. 1.Department of Gastroenterological SurgeryKumamoto University Graduate School of Medical SciencesKumamotoJapan
  2. 2.Institute of Resource Development and AnalysisKumamoto University Graduate School of Medical SciencesKumamotoJapan
  3. 3.Department of SurgeryKumamoto Regional Medical CenterKumamotoJapan

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