title: Resectable carcinoma developing in the remnant pancreas 7 years and 10 months after distal pancreatectomy for invasive ductal carcinoma of the pancreas: report of a case.
abstract: BACKGROUND
  Pancreatic ductal adenocarcinoma, which represents 90% of pancreatic cancers, is one of the most lethal and aggressive malignancies. Operative resection remains the only treatment providing prolonged survival, however, recurrence of pancreatic ductal adenocarcinoma occurs in up to 80% of patients with pancreatic cancer within 2 years of a potential curative resection. There are few reports of pancreatic carcinoma recurrence (primary second cancer) in the remnant pancreas after pancreatectomy.
  
  
  METHODS
  A 52-year-old woman underwent a distal pancreatectomy for pancreatic cancer in September 2004. Adjuvant chemotherapy was started after surgery and continued for 4 years. In March 2012, marked elevation of DUPAN-II was observed, followed by an irregular stenotic finding in the main duct. We performed an en bloc resection of the remnant pancreas in July 2012. Histologically, the tumor contained a second primary pancreatic carcinoma with lymph node metastasis. At follow-up 20 months after the second operation, the patient was alive without recurrence. Fourteen cases of resectable cancer developing in the remnant pancreas after a pancreatectomy for cancer have been reported; a minority of these was identified as second primary tumors. Therefore, our patient's primary second cancer is a rare event.
  
  
  CONCLUSIONS
  The patient is considered to have shown a rare, unique pancreatic cancer recurrence. Persistent elevation of a tumor marker and extensive imaging led to proper diagnosis and treatment.
authors.affiliation: Department of Surgery,, Shiga University of Medical Science, Seta Tsukinowa-cho, Otsu, Shiga, Japan. hakabori@belle.shiga-med.ac.jp.
authors.forename: Hiroya
authors.initials: H
authors.lastname: Akabori
authors.forename: Hisanori
authors.initials: H
authors.lastname: Shiomi
authors.forename: Shigeyuki
authors.initials: S
authors.lastname: Naka
authors.forename: Koichiro
authors.initials: K
authors.lastname: Murakami
authors.forename: Satoshi
authors.initials: S
authors.lastname: Murata
authors.forename: Mitsuaki
authors.initials: M
authors.lastname: Ishida
authors.forename: Yoshimasa
authors.initials: Y
authors.lastname: Kurumi
authors.forename: Tohru
authors.initials: T
authors.lastname: Tani
mesh_terms: D021441:Carcinoma, Pancreatic Ductal / Q000209:etiology* / Q000556:secondary / Q000601:surgery*; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis; D008875:Middle Aged; D016609:Neoplasms, Second Primary / Q000209:etiology*; D010180:Pancreatectomy; D010190:Pancreatic Neoplasms / Q000473:pathology / Q000601:surgery*; D011379:Prognosis; D012086:Reoperation