Abstract
We report a rare case of a curative resection performed on a carcinoma developing in the remnant pancreas at 3 years 7 months after a pancreaticoduodenectomy for pancreatic cancer. A 63-year-old man underwent a pancreaticoduodenectomy for pancreatic cancer on November 1999. Because the celiac trunk was occluded by atherosclerosis, an aortohepatic bypass with a saphenous vein graft was performed simultaneously. In May 2003, tumor marker levels increased, and a tumor was detected in the remnant pancreas on computed tomography. There were no findings such as invasion into the surrounding tissue or distant metastasis, and therefore we removed the remnant pancreas in July 2003. Histopathologically, the tumor consisted of a well-differentiated tubular adenocarcinoma and was limited to the pancreas. Moreover, the anastomotic site of the pancreaticojejunostomy was negative for cancer, and some foci of papillary hyperplasia and goblet cell metaplasia of the pancreatic ductal epithelium, which was thought to be the precursor of the pancreatic cancer, were seen. These findings suggested that the tumor was a second primary cancer developing in the remnant pancreas. This case provided suggestive evidence for the development of pancreatic cancer, and the surgical procedure for a pancreaticoduodenectomy with occlusion of the celiac trunk is discussed.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Sobin L, Wittekind C. UICC TNM Classification of Malignant Tumours. New York: Wiley-Liss, 1997.
Yeo CJ, Cameron JL, Lillemoe KD, et al. Pancreaticoduodenectomy for cancer of the head of the pancreas. 201 Patients. Ann Surg 1995;221:721–731; discussion 731–733.
Ishikawa O, Wada H, Ohigashi H, et al. Postoperative cytology for drained fluid from the pancreatic bed after "curative" resection of pancreatic cancers: Does it predict both the patient’s prognosis and the site of cancer recurrence? Ann Surg 2003;238:103–110.
Sperti C, Pasquali C, Piccoli A, Pedrazzoli S. Recurrence after resection for ductal adenocarcinoma of the pancreas. World J Surg 1997;21:195–200.
Kayahara M, Nagakawa T, Ueno K, Ohta T, Takeda T, Miyazaki I. An evaluation of radical resection for pancreatic cancer based on the mode of recurrence as determined by autopsy and diagnostic imaging. Cancer 1993;72:2118–2123.
Westerdahl J, Andren-Sandberg A, Ihse I. Recurrence of exocrine pancreatic cancer—Local or hepatic? Hepatogastroenterology 1993;40:384–387.
Griffin JF, Smalley SR, Jewell W, et al. Patterns of failure after curative resection of pancreatic carcinoma. Cancer 1990;66:56–61.
Willett CG, Lewandrowski K, Warshaw AL, Efird J, Compton CC. Resection margins in carcinoma of the head of the pancreas. Implications for radiation therapy. Ann Surg 1993; 217:144–148.
Kozuka S, Sassa R, Taki T, et al. Relation of pancreatic duct hyperplasia to carcinoma. Cancer 1979;43:1418–1428.
Kloppel G, Bommer G, Ruckert K, Seifert G. Intraductal proliferation in the pancreas and its relationship to human and experimental carcinogenesis. Virchows Arch A Pathol Anat Histol 1980;387:221–233.
Brat DJ, Lillemoe KD, Yeo CJ, Warfield PB, Hruban RH. Progression of pancreatic intraductal neoplasias to infiltrating adenocarcinoma of the pancreas. Am J Surg Pathol 1998;22:163–169.
Brockie E, Anand A, Albores-Saavedra J. Progression of atypical ductal hyperplasia/carcinoma in situ of the pancreas to invasive adenocarcinoma. Ann Diagn Pathol 1998;2:286–292.
Koizumi K, Kometani H, Shishioka I, et al. A case of resectable carcinoma of the head of the pancreas developing 1 year and 4 months after tail and body pancreatectomy for small carcinoma of the body of the pancreas. [in Japanese with English abstract]. Suizou (J Jpn Panc Soc) 1988;3:499–504.
Eriguchi N, Aoyagi S, Imayama H, et al. Resectable carcinoma of the pancreatic head developing 7 years and 4 months after distal pancreatectomy for carcinoma of the pancreatic tail. J Hepatobiliary Pancreat Surg 2000;7:316–320.
D’Amato A, Gentili V, Santella S, Boschetto A, Pronio A, Montesani C. [Carcinoma of the pancreatic remnant developing after pancreaticoduodenectomy for adenocarcinoma of the head of pancreas.] Chir Ital 2002;54:539–544.
Wada K, Takada T, Yasuda H, Amano H, Yoshida M. A repeated pancreatectomy in the remnant pancreas 22 months after pylorus-preserving pancreatoduodenectomy for pancreatic adenocarcinoma. J Hepatobiliary Pancreat Surg 2001;8:174–178.
Ihse I, Lilja P, Arnesjo B, Bengmark S. Total pancreatectomy for cancer. An appraisal of 65 cases. Ann Surg 1977;186:675–680.
Tryka AF, Brooks JR. Histopathology in the evaluation of total pancreatectomy for ductal carcinoma. Ann Surg 1979; 190:373–381.
van Heerden JA, ReMine WH, Weiland LH, McIlrath DC, Ilstrup DM. Total pancreatectomy for ductal adenocarcinoma of the pancreas. Mayo Clinic experience. AmJ Surg 1981;142:308–311.
Sarr MG, Behrns KE, van Heerden JA. Total pancreatectomy. An objective analysis of its use in pancreatic cancer. Hepatogastroenterology 1993;40:418–421.
Thompson NW, Eckhauser FE, Talpos G, Cho KJ. Pancreaticoduodenectomy and celiac occlusive disease. Ann Surg 1981; 193:399–406.
Berney T, Pretre R, Chassot G, Morel P. The role of revascularization in celiac occlusion and pancreatoduodenectomy. Am J Surg 1998;176:352–356.
Miyata M, Takao T, Okuda A, Sasako Y, Sunada S. Pancreatoduodenectomy for periampullary cancer associated with celiac occlusion: A case report. Surgery 1988;103:261–263.
Okamoto H, Suminaga Y, Toyama N, Konishi F, Kawahito H. Autogenous vein graft from iliac artery to splenic artery for celiac occlusion in pancreaticoduodenectomy. J Hepatobiliary Pancreat Surg 2003;10:109–112.
Fortner JG, Watson RC. Median arcuate ligament obstruction of celiac axis and pancreatic cancer. Ann Surg 1981; 194:698–700.
Bull DA, Hunter GC, Crabtree TG, Bernhard VM, Putnam CW. Hepatic ischemia, caused by celiac axis compression, complicating pancreaticoduodenectomy. Ann Surg 1993;217:244–247.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Takamatsu, S., Ban, D., Irie, T. et al. Resection of a cancer developing in the remnant pancreas after a pancreaticoduodenectomy for pancreas head cancer. J Gastrointest Surg 9, 263–269 (2005). https://doi.org/10.1016/j.gassur.2004.05.016
Issue Date:
DOI: https://doi.org/10.1016/j.gassur.2004.05.016