title: Resection of metachronous pancreatic cancer 4 years after pancreaticoduodenectomy for stage III pancreatic adenocarcinoma.
abstract: Pancreatic adenocarcinoma frequently recurs in patients even after resection with curative intent. The majority of these are early recurrences and are associated with metastatic disease, thus not amenable to repeat resection. Here we report a patient who underwent completion pancreatectomy for a metachronous pancreatic adenocarcinoma. This patient initially presented with painless jaundice and computed tomography (CT) revealed a mass in the head of the pancreas. Brushings obtained at endoscopic retrograde cholangiopancreatography (ERCP) were positive for adenocarcinoma. This patient then underwent a Whipple procedure and final pathology demonstrated stage III pancreatic ductal adenocarcinoma. Adjuvant therapy included gemcitabine and erlotinib. This patient was followed with physical examinations and serial laboratory and imaging studies. There was no evidence of disease for four years at which time and sharp elevation in CA-19-9 was found. Subsequent imaging revealed a mass in the remnant pancreas. Curative intent completion pancreatectomy was then performed which confirmed the presence of pancreatic adenocarcinoma. This was followed by adjuvant Gemcitabine based chemotherapy and chemoradiation. One year later the patient is alive with no evidence of disease. Thus, in highly selected patients with recurrent or metachronous pancreatic cancer, repeat pancreatectomy can be considered, but the course of treatment should be considered in a multidisciplinary setting.
authors.affiliation: Department of Surgery, City of Hope Comprehensive Cancer Center, Duarte, CA, USA. jham_42@hotmail.com.|Tulane University School of Medicine, New Orleans, LA, USA. jham_42@hotmail.com.
authors.forename: John B
authors.initials: JB
authors.lastname: Hamner
authors.affiliation: Department of Surgery, City of Hope Comprehensive Cancer Center, Duarte, CA, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: White
authors.affiliation: Department of Surgery, City of Hope Comprehensive Cancer Center, Duarte, CA, USA.
authors.forename: Carly
authors.initials: C
authors.lastname: Crowder
authors.affiliation: Department of Surgery, City of Hope Comprehensive Cancer Center, Duarte, CA, USA.
authors.forename: Gagandeep
authors.initials: G
authors.lastname: Singh
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000601:surgery* / Q000628:therapy; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D021441:Carcinoma, Pancreatic Ductal / Q000473:pathology / Q000601:surgery* / Q000628:therapy; D003131:Combined Modality Therapy; D003841:Deoxycytidine / Q000008:administration & dosage / Q000031:analogs & derivatives; D000069347:Erlotinib Hydrochloride / Q000008:administration & dosage; D005260:Female; D006801:Humans; D009364:Neoplasm Recurrence, Local / Q000473:pathology / Q000601:surgery* / Q000628:therapy; D009367:Neoplasm Staging; D016609:Neoplasms, Second Primary; D010190:Pancreatic Neoplasms / Q000473:pathology / Q000601:surgery* / Q000628:therapy; D016577:Pancreaticoduodenectomy; D011379:Prognosis; D000093542:Gemcitabine
chemical_list: D003841:Deoxycytidine; D000069347:Erlotinib Hydrochloride; D000093542:Gemcitabine