title: Unresectable pancreatic ductal adenocarcinoma in the remnant pancreas diagnosed during every-6-month surveillance after resection of branch duct intraductal papillary mucinous neoplasm: a case report.
abstract: BACKGROUND
  There are few studies regarding the surveillance period and interval of resected or observed branch duct intraductal papillary mucinous neoplasms (IPMNs) of the pancreas in terms of early detection of concomitant pancreatic ductal adenocarcinoma. Despite a strict surveillance protocol, some patients are diagnosed with metastatic distinct ductal adenocarcinoma after resection of IPMN.
  
  
  METHODS
  We herein report a patient with unresectable pancreatic ductal adenocarcinoma that developed in the remnant pancreas 18 months after resection of branch duct IPMN. Although the patient was surveyed every 6 months after the operation and imaging studies at 6 and 12 months postoperatively demonstrated no evidence of recurrence, invasive ductal adenocarcinoma with liver metastasis appeared 18 months after the operation. The patient subsequently underwent chemotherapy; however, he died 9 months after the diagnosis of metachronous pancreatic ductal adenocarcinoma.
  
  
  CONCLUSIONS
  In some patients with branch duct IPMNs, 6-month surveillance seems to be insufficient to detect resectable concomitant pancreatic ductal adenocarcinoma. Therefore, identification of high-risk patients who require surveillance at shorter intervals is urgently needed.
authors.affiliation: Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University. Fukuoka, Japan.
authors.forename: Koji
authors.initials: K
authors.lastname: Tamura
authors.forename: Takao
authors.initials: T
authors.lastname: Ohtsuka
authors.forename: Noboru
authors.initials: N
authors.lastname: Ideno
authors.forename: Teppei
authors.initials: T
authors.lastname: Aso
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Kono
authors.forename: Yousuke
authors.initials: Y
authors.lastname: Nagayoshi
authors.forename: Koji
authors.initials: K
authors.lastname: Shindo
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Ushijima
authors.forename: Junji
authors.initials: J
authors.lastname: Ueda
authors.forename: Shunichi
authors.initials: S
authors.lastname: Takahata
authors.forename: Tetsuhide
authors.initials: T
authors.lastname: Ito
authors.forename: Yoshinao
authors.initials: Y
authors.lastname: Oda
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Mizumoto
authors.forename: Masao
authors.initials: M
authors.lastname: Tanaka
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis* / Q000601:surgery; D002288:Adenocarcinoma, Mucinous / Q000473:pathology* / Q000601:surgery; D021441:Carcinoma, Pancreatic Ductal / Q000473:pathology* / Q000601:surgery; D002291:Carcinoma, Papillary / Q000473:pathology* / Q000601:surgery; D017809:Fatal Outcome; D006801:Humans; D008113:Liver Neoplasms / Q000556:secondary; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D010183:Pancreatic Ducts / Q000473:pathology*; D010190:Pancreatic Neoplasms / Q000175:diagnosis* / Q000601:surgery; D013997:Time Factors