title: Pancreatic carcinoma recurrence in the remnant pancreas after a pancreaticoduodenectomy.
abstract: BACKGROUND
  We report a rare case of a repeated pancreatic resection in the remnant distal pancreas 18 months after a Whipple R0 procedure.
  
  
  METHODS
  In September 2003, a 63-year-old man underwent a Whipple procedure with an extended lymphadenectomy, portal vein resection and direct reconstruction for pancreatic cancer. In September 2004, the tumor marker level increased and MR revealed a tumor in the remnant pancreas. There were no findings of invasion into the surrounding tissue or distant metastasis. After three months of systemic chemotherapy and a radiological reevaluation (PET and CT) in March 2005, we removed the remnant pancreas. Histopathologically, the tumor was classified as a ductal adenocarcinoma like the tumor which had been removed during the first operation, with infiltration of peripancreatic adipose tissue and a segmentary tract of the transverse mesocolon, without lymph node metastasis.
  
  
  CONCLUSIONS
  There are very few reports of pancreatic carcinoma recurrence in the remnant pancreas after a pancreaticoduodenectomy in the literature. In most of these cases, it is difficult to assess whether the remnant pancreatic cancer is a recurrence or a second primary cancer. In our patient, the first hypothesis seems to be more realistic due to the brief recurrence-free survival period. Otherwise the high rate of multicentricity in pancreatic cancer may also explain the development of a secondary cancer in the remnant pancreas, even though the interval was relatively brief.
authors.affiliation: Department of Surgery and Transplantation, University of Parma, Parma, Italy. r.dalval@unipr.it
authors.forename: Raffaele
authors.initials: R
authors.lastname: Dalla Valle
authors.forename: Cristina
authors.initials: C
authors.lastname: Mancini
authors.forename: Pellegrino
authors.initials: P
authors.lastname: Crafa
authors.forename: Rodolfo
authors.initials: R
authors.lastname: Passalacqua
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000601:surgery; D021441:Carcinoma, Pancreatic Ductal / Q000473:pathology* / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology* / Q000601:surgery; D010179:Pancreas / Q000473:pathology; D010190:Pancreatic Neoplasms / Q000473:pathology* / Q000601:surgery*; D016577:Pancreaticoduodenectomy; D011183:Postoperative Complications / Q000473:pathology / Q000601:surgery; D012086:Reoperation