title: Postsurgery activation of dormant liver micrometastasis: a case report and review of literature.
abstract: BACKGROUND
  We present the case of a 55-year-old woman who underwent a Whipple procedure for pancreatic adenocarcinoma. The preoperative work-up showed no signs of liver metastasis and confirmed the patient's operability, but at less than 40 days postoperatively there were diffuse liver metastasis present on CT. This rapid evolution raises the question whether current staging systems are adequate in determining a patient's operability. It also suggests an interaction between the primary tumor and the host and the existence of disseminated tumor cells.
  
  
  CONCLUSIONS
  In this article, we give an explanation for the clinical evolution presented in our case using the "integrated organ" and the "concomitant resistance" hypotheses. We believe that, if these theories continue to prove their viability, the search for disseminated tumor cells will be essential for good clinical practice in this type of pathology.
authors.affiliation: Department of General and Digestive Surgery, AZ Groeninge, Kortrijk, Belgium. bert.deylgat@hotmail.com
authors.forename: Bert
authors.initials: B
authors.lastname: Deylgat
authors.forename: Frank
authors.initials: F
authors.lastname: Van Rooy
authors.forename: Franky
authors.initials: F
authors.lastname: Vansteenkiste
authors.forename: Dirk
authors.initials: D
authors.lastname: Devriendt
authors.forename: Christophe
authors.initials: C
authors.lastname: George
mesh_terms: D000230:Adenocarcinoma / Q000556:secondary* / Q000601:surgery*; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000556:secondary*; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000473:pathology / Q000601:surgery*; D011183:Postoperative Complications; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome