Limits...
Resection of metachronous pancreatic cancer 4 years after pancreaticoduodenectomy for stage III pancreatic adenocarcinoma.

Hamner JB, White M, Crowder C, Singh G - World J Surg Oncol (2015)

Bottom Line: The majority of these are early recurrences and are associated with metastatic disease, thus not amenable to repeat resection.There was no evidence of disease for four years at which time and sharp elevation in CA-19-9 was found.One year later the patient is alive with no evidence of disease.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, City of Hope Comprehensive Cancer Center, Duarte, CA, USA. jham_42@hotmail.com.

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.

No MeSH data available.


Related in: MedlinePlus

Representative cuts of the patient’s initial CT scan demonstrating intrahepatic biliary ductal dilatation (a) and a heterogeneous mass within the head of the pancreas (b)
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
getmorefigures.php?uid=PMC4588897&req=5

Fig1: Representative cuts of the patient’s initial CT scan demonstrating intrahepatic biliary ductal dilatation (a) and a heterogeneous mass within the head of the pancreas (b)

Mentions: In February 2010, a then 69-year-old female presented to her family physician with weight loss, early satiety and jaundice without abdominal pain, nausea, or vomiting. She was otherwise in excellent medical condition with her only significant past medical or surgical history being cervical carcinoma in situ treated with hysterectomy at age 29. She had no history of smoking and used alcohol only on rare social occasions. In addition, there was no family history of any malignant disease. Her initial workup included laboratory investigations that were significant for hyperbilirubinemia of 8.7 mcg/dL. This was followed by computed tomography (CT) of the abdomen and pelvis that revealed significant intra- and extrahepatic ductal dilatation (Fig. 1a) and a 2.69 × 2.64 cm mass in the head of the pancreas (Fig. 1b). There was no evidence of peripancreatic, periportal, mesenteric, or celiac axis adenopathy, nor was there evidence of distant metastatic disease. In addition, there was no abutment on the mass to the portal vein or the superior mesenteric artery and vein. Based on these initial CT findings, this was a resectable pancreatic head mass.Fig. 1


Resection of metachronous pancreatic cancer 4 years after pancreaticoduodenectomy for stage III pancreatic adenocarcinoma.

Hamner JB, White M, Crowder C, Singh G - World J Surg Oncol (2015)

Representative cuts of the patient’s initial CT scan demonstrating intrahepatic biliary ductal dilatation (a) and a heterogeneous mass within the head of the pancreas (b)
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4588897&req=5

Fig1: Representative cuts of the patient’s initial CT scan demonstrating intrahepatic biliary ductal dilatation (a) and a heterogeneous mass within the head of the pancreas (b)
Mentions: In February 2010, a then 69-year-old female presented to her family physician with weight loss, early satiety and jaundice without abdominal pain, nausea, or vomiting. She was otherwise in excellent medical condition with her only significant past medical or surgical history being cervical carcinoma in situ treated with hysterectomy at age 29. She had no history of smoking and used alcohol only on rare social occasions. In addition, there was no family history of any malignant disease. Her initial workup included laboratory investigations that were significant for hyperbilirubinemia of 8.7 mcg/dL. This was followed by computed tomography (CT) of the abdomen and pelvis that revealed significant intra- and extrahepatic ductal dilatation (Fig. 1a) and a 2.69 × 2.64 cm mass in the head of the pancreas (Fig. 1b). There was no evidence of peripancreatic, periportal, mesenteric, or celiac axis adenopathy, nor was there evidence of distant metastatic disease. In addition, there was no abutment on the mass to the portal vein or the superior mesenteric artery and vein. Based on these initial CT findings, this was a resectable pancreatic head mass.Fig. 1

Bottom Line: The majority of these are early recurrences and are associated with metastatic disease, thus not amenable to repeat resection.There was no evidence of disease for four years at which time and sharp elevation in CA-19-9 was found.One year later the patient is alive with no evidence of disease.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, City of Hope Comprehensive Cancer Center, Duarte, CA, USA. jham_42@hotmail.com.

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.

No MeSH data available.


Related in: MedlinePlus