title: Back pain as a potential indicator of local recurrence in pancreatic cancer.
abstract: Neural invasion (NI) and severe pain are common features in patients with pancreatic cancer (PCa). Here, we present the case of a 67-year-old patient with PCa whose pre- and postoperative physical situation was clearly dominated by severe pain sensation. The resected pancreas specimen revealed severe and frequent NI by cancer cells. Seven months after R1 resection and additive chemotherapy, the patient presented with severe lumbar back pain. The CT scan showed liver metastasis and local recurrence around the celiac trunk. Yet 1 month after palliative chemotherapy, the patient presented again in poor general condition and lumbar pain requiring constant morphine intake, and died 2 days after hospitalization. Postmortem histological analysis showed local recurrence with an extensive invasion by cancer cells along almost all nerves of the celiac plexus. Hence, new-onset or recurrent back and/or abdominal pain, as in this case, should raise the clinician's suspicion for local recurrence in PCa.
authors.affiliation: Department of Surgery, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.
authors.forename: Elke
authors.initials: E
authors.lastname: Tieftrunk
authors.affiliation: Department of Surgery, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.
authors.forename: Ihsan Ekin
authors.initials: IE
authors.lastname: Demir
authors.affiliation: Department of Surgery, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.
authors.forename: Helmut
authors.initials: H
authors.lastname: Friess
authors.affiliation: Department of Surgery, Klinikum rechts der Isar, Technische Universität München, Munich, Germany gueralp.ceyhan@tum.de.
authors.forename: Güralp O
authors.initials: GO
authors.lastname: Ceyhan