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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 cut of the patient’s CT scan in March of 2013, 4 years after the initial surgery. This demonstrates a mass within the pancreatic remnant suspicious for carcinoma
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Fig2: Representative cut of the patient’s CT scan in March of 2013, 4 years after the initial surgery. This demonstrates a mass within the pancreatic remnant suspicious for carcinoma

Mentions: Postoperatively, she received adjuvant therapy with 3 cycles of gemcitabine monotherapy followed by an additional 3 cycles of gemcitabine with erlotinib. She underwent routine follow-up with physical examination, imaging, and laboratory studies on a semiannual basis. From late 2010 after completing adjuvant therapy until March 2014, she showed no evidence of disease with multiple negative imaging studies and CA19-9 levels ranging from 12.1 to 44.5 U/mL. In March 2014, however, her CA 19-9 increased to 161.4 U/mL. A CT done at this time (Fig. 2) showed a 2.1 × 2 cm mass in the body of the pancreas suspicious for recurrent or metachronous tumor. By CT, there was no evidence of disease outside of the pancreas. The CT was followed by PET-CT (Fig. 3) that demonstrated this PET avid lesion in the pancreas with a maximum SUV of 5.9 g/mL with no evidence of metastatic disease, again suspicious for pancreatic cancer. The patient’s case was presented at a multidisciplinary tumor conference with discussions on how to proceed with treatment, with the main questions focused on neoadjuvant therapy versus resection followed by adjuvant therapy if the mass is proven to be pancreatic carcinoma. Because of the long disease-free interval and the fact that the mass appeared resectable, the tumor board’s recommendation was to proceed with surgery first.Fig. 2


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 cut of the patient’s CT scan in March of 2013, 4 years after the initial surgery. This demonstrates a mass within the pancreatic remnant suspicious for carcinoma
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

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

Fig2: Representative cut of the patient’s CT scan in March of 2013, 4 years after the initial surgery. This demonstrates a mass within the pancreatic remnant suspicious for carcinoma
Mentions: Postoperatively, she received adjuvant therapy with 3 cycles of gemcitabine monotherapy followed by an additional 3 cycles of gemcitabine with erlotinib. She underwent routine follow-up with physical examination, imaging, and laboratory studies on a semiannual basis. From late 2010 after completing adjuvant therapy until March 2014, she showed no evidence of disease with multiple negative imaging studies and CA19-9 levels ranging from 12.1 to 44.5 U/mL. In March 2014, however, her CA 19-9 increased to 161.4 U/mL. A CT done at this time (Fig. 2) showed a 2.1 × 2 cm mass in the body of the pancreas suspicious for recurrent or metachronous tumor. By CT, there was no evidence of disease outside of the pancreas. The CT was followed by PET-CT (Fig. 3) that demonstrated this PET avid lesion in the pancreas with a maximum SUV of 5.9 g/mL with no evidence of metastatic disease, again suspicious for pancreatic cancer. The patient’s case was presented at a multidisciplinary tumor conference with discussions on how to proceed with treatment, with the main questions focused on neoadjuvant therapy versus resection followed by adjuvant therapy if the mass is proven to be pancreatic carcinoma. Because of the long disease-free interval and the fact that the mass appeared resectable, the tumor board’s recommendation was to proceed with surgery first.Fig. 2

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