title: Resection of a cancer developing in the remnant pancreas after a pancreaticoduodenectomy for pancreas head cancer.
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.
authors.affiliation: Department of Hepato-Biliary-Pancreatic Surgery, Tokyo Medical and Dental University, Graduate School of Medicine, Tokyo 113-8519, Japan. takamatsu.srg1@med.tmd.ac.jp
authors.forename: Susumu
authors.initials: S
authors.lastname: Takamatsu
authors.forename: Daisuke
authors.initials: D
authors.lastname: Ban
authors.forename: Takumi
authors.initials: T
authors.lastname: Irie
authors.forename: Norio
authors.initials: N
authors.lastname: Noguchi
authors.forename: Atsushi
authors.initials: A
authors.lastname: Kudoh
authors.forename: Noriaki
authors.initials: N
authors.lastname: Nakamura
authors.forename: Tohru
authors.initials: T
authors.lastname: Kawamura
authors.forename: Tohru
authors.initials: T
authors.lastname: Igari
authors.forename: Kenichi
authors.initials: K
authors.lastname: Teramoto
authors.forename: Shigeki
authors.initials: S
authors.lastname: Arii
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000601:surgery*; D000714:Anastomosis, Surgical; D004108:Dilatation, Pathologic; D006801:Humans; D008297:Male; D008875:Middle Aged; D018365:Neoplasm, Residual / Q000000981:diagnostic imaging / Q000601:surgery*; D010183:Pancreatic Ducts / Q000473:pathology; D010190:Pancreatic Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D016577:Pancreaticoduodenectomy; D014057:Tomography, X-Ray Computed