title: Long-term survival with surgery for metachronous retroperitoneal lymph node and pancreatic metastases after curative resection of rectal cancer: a case report.
abstract: BACKGROUND
  The possible benefits of the surgical resection of multiple metastases in rare sites from colorectal cancer (CRC) are still unclear. Therefore, more cases are needed to investigate the surgical outcomes of these diseases. A very rare case in which the simultaneous resection of both the metachronous retroperitoneal lymph node and pancreatic metastases from rectal cancer was successfully performed is reported.
  
  
  METHODS
  A 68-year-old man had undergone low anterior resection for rectal cancer. Eight months later, computed tomography showed an enlarged lymph node located below the aortic bifurcation and a pancreatic head tumor. Positron emission tomography showed increased focal uptake in these two lesions. With a diagnosis of retroperitoneal lymph node metastasis from rectal cancer and primary pancreatic cancer or pancreatic metastasis from rectal cancer, resection of the enlarged retroperitoneal lymph node and pancreaticoduodenectomy were performed. The pathological examination showed that both resected lesions were metastases from the primary rectal cancer. After the metastasectomy, the patient was given systemic chemotherapy, which was discontinued due to an adverse event. He was then followed up routinely without any medication. Sixty-nine months after the metastasectomy, he is alive without any indication of recurrence.
  
  
  CONCLUSIONS
  Thus, even with metastases from CRC located in rare sites, an acceptable outcome can be expected following curative surgical resection in carefully selected patients. Whenever possible, an aggressive surgical approach should be included in the multimodality treatment of metastatic CRC.
authors.affiliation: Division of Colon and Rectal Surgery, Shizuoka Cancer Center Hospital, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan.
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Hino
authors.affiliation: Division of Colon and Rectal Surgery, Shizuoka Cancer Center Hospital, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan. h.kagawa@scchr.jp.
authors.forename: Hiroyasu
authors.initials: H
authors.lastname: Kagawa
authors.affiliation: Division of Colon and Rectal Surgery, Shizuoka Cancer Center Hospital, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan.
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Kinugasa
authors.affiliation: Division of Colon and Rectal Surgery, Shizuoka Cancer Center Hospital, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan.
authors.forename: Akio
authors.initials: A
authors.lastname: Shiomi
authors.affiliation: Division of Colon and Rectal Surgery, Shizuoka Cancer Center Hospital, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan.
authors.forename: Tomohiro
authors.initials: T
authors.lastname: Yamaguchi
authors.affiliation: Division of Colon and Rectal Surgery, Shizuoka Cancer Center Hospital, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan.
authors.forename: Yushi
authors.initials: Y
authors.lastname: Yamakawa
authors.affiliation: Division of Colon and Rectal Surgery, Shizuoka Cancer Center Hospital, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan.
authors.forename: Masakatsu
authors.initials: M
authors.lastname: Numata
authors.affiliation: Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center Hospital, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan.
authors.forename: Teiichi
authors.initials: T
authors.lastname: Sugiura
authors.affiliation: Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center Hospital, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan.
authors.forename: Katsuhiko
authors.initials: K
authors.lastname: Uesaka
keywords: Pancreatic metastasis; Rectal cancer; Recurrence; Retroperitoneal lymph node metastasis; Surgery