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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

Follow-up CT 11 months after completion pancreatectomy. At this point, the patient has completed adjuvant chemotherapy and chemoradiation and there is no evidence of disease
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Fig4: Follow-up CT 11 months after completion pancreatectomy. At this point, the patient has completed adjuvant chemotherapy and chemoradiation and there is no evidence of disease

Mentions: Following surgery, she received adjuvant therapy consisting of 3 cycles of gemcitabine. This was followed by chemoradiation that included 45 Gy in 25 fractions with concurrent capecitabine. She completed adjuvant therapy in October 2014, and as of March 2015, she has no clinical evidence of disease recurrence(Fig. 4) and a Ca19-9 of 28.5.


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)

Follow-up CT 11 months after completion pancreatectomy. At this point, the patient has completed adjuvant chemotherapy and chemoradiation and there is no evidence of disease
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

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

Fig4: Follow-up CT 11 months after completion pancreatectomy. At this point, the patient has completed adjuvant chemotherapy and chemoradiation and there is no evidence of disease
Mentions: Following surgery, she received adjuvant therapy consisting of 3 cycles of gemcitabine. This was followed by chemoradiation that included 45 Gy in 25 fractions with concurrent capecitabine. She completed adjuvant therapy in October 2014, and as of March 2015, she has no clinical evidence of disease recurrence(Fig. 4) and a Ca19-9 of 28.5.

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