Long-term survival after resection of pancreatic ductal adenocarcinoma with para-aortic lymph node metastasis: case report.
Pancreatic cancer patients with para-aortic lymph node metastasis have a poor prognosis and patients living longer than 3 years are rare. We had a patient with pancreatic cancer who survived for more than 10 years after removal of the para-aortic lymph node metastasis. A 57-year-old woman was diagnosed with pancreatic head cancer and underwent a pancreaticoduodenectomy with subtotal gastric resection following Whipple reconstruction in 2000. Para-aortic lymph node metastasis was detected during the operation by intraoperative pathological diagnosis and an extended lymphadenectomy was performed with vascular skeletonization of the celiac and superior mesenteric arteries. In 2004, a low-density area was detected around the superior mesenteric artery (SMA) 5 cm from its root and she was treated with gemcitabine, and the area was undetectable after 3 years of treatment. In 2010, computed tomography showed a low-density area around the same lesion with an increased carcinoembryonic antigen level. After 4 months of gemcitabine treatment, we resected the tumor en bloc with the associated superior mesenteric vein and perineural tissue. Histopathological examination of the resected specimen revealed a well-differentiated tubular adenocarcinoma that closely resembled the original primary pancreatic cancer, indicating perineural recurrence 10 years after the initial resection. She had no recurrence around the SMA for more than one year. Although a meta-analysis has not proved the efficacy of preventive radical dissection, this case indicates that a patient with well-differentiated, chemotherapy-responsive pancreatic cancer with para-aortic lymph node metastasis could have a long survival time through extended dissection of the lymph nodes.
Department of Surgery, Kyoto University, Kyoto, Japan. tmasui@kuhp.kyoto-u.ac.jp
Toshihiko
T
Masui
Toyonari
T
Kubota
Keiko
K
Aoki
Yasutaka
Y
Nakanishi
Takumi
T
Miyamoto
Junko
J
Nagata
Koshiro
K
Morino
Atsushi
A
Fukugaki
Michio
M
Takamura
Shinichi
S
Sugimoto
Hideyuki
H
Onuma
Atsuo
A
Tokuka
D000230:Adenocarcinoma / Q000401:mortality* / Q000556:secondary / Q000601:surgery; D001012:Aorta, Abdominal / Q000473:pathology* / Q000601:surgery; D021441:Carcinoma, Pancreatic Ductal / Q000401:mortality* / Q000556:secondary / Q000601:surgery; D005260:Female; D005743:Gastrectomy / Q000401:mortality; D006801:Humans; D008197:Lymph Node Excision / Q000401:mortality; D008207:Lymphatic Metastasis; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D010190:Pancreatic Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D016577:Pancreaticoduodenectomy / Q000401:mortality; D011379:Prognosis; D015996:Survival Rate; D014057:Tomography, X-Ray Computed