title: Second surgery after a pancreaticoduodenectomy in patients with periampullary malignancies.
abstract: OBJECTIVE
  Few case reports have previously documented a second surgery after pancreaticoduodenectomy due to recurrence or other reasons in patients with periampullary malignancies. The present report summarized the experience of this clinic with secondary surgery after Pancreaticoduodenectomy (PD).
  
  
  METHODS
  During the past 7 years, 7 out of 95 patients with periampullary malignancies underwent a second surgery after pancreaticoduodenectomy at this institution. The clinical courses of these patients are presented and 2 interesting cases are shown in the present study.
  
  
  RESULTS
  One patient with lower bile duct adenocarcinoma underwent a remnant splenopancreatectomy due to pancreatic recurrence 36 months after pancreaticoduodenectomy. The other patient with lower bile duct adenocarcinoma underwent a hepatectomy due to a solitary liver metastasis 47 months after a pancreaticoduodenectomy. These 2 patients have survived 4 and 13 months after the second surgery. In the 7 patients requiring secondary surgery, 5 underwent the procedure due to recurrent disease, and 4 of the 5 received the second surgery to remove the lesion. The mean interval between pancreaticoduodenectomy and the second operation was 32 months in the 5 patients with recurrent disease and 27 months in the all 7 patients. One of the 5 patients died of recurrent disease only 5 months after the second procedure because the surgery was a palliative bypass. However, the other 3 survived more than 1 year after the resection of the lesion at the recurrent site.
  
  
  CONCLUSIONS
  The present study reports 2 rare cases with lower bile duct adenocarcinoma in which a recurrent tumor was removed after pancreaticoduodenectomy. In this study, 4 patients undergoing a curative re-operation survived more than 1 year after the surgery. The present study was small, but the findings are significant because of the scarcity of reports of patients undergoing secondary surgery after PD.
authors.affiliation: Department of Gastroenterological Surgery, St. Marianna University Hospital, Kawasaki, Japan. nakahiro@marianna-u.ac.jp
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Nakano
authors.forename: Takeshi
authors.initials: T
authors.lastname: Asakura
authors.forename: Satoshi
authors.initials: S
authors.lastname: Koizumi
authors.forename: Takayuki
authors.initials: T
authors.lastname: Asano
authors.forename: Taiji
authors.initials: T
authors.lastname: Watanabe
authors.forename: Takehito
authors.initials: T
authors.lastname: Otsubo
authors.forename: Kenji
authors.initials: K
authors.lastname: Takizawa
mesh_terms: D000368:Aged; D014670:Ampulla of Vater; D003138:Common Bile Duct Neoplasms / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000601:surgery*; D016577:Pancreaticoduodenectomy; D012086:Reoperation