Pancreatic carcinoma recurrence in the remnant pancreas after a pancreaticoduodenectomy.

CONTEXT We report a rare case of a repeated pancreatic resection in the remnant distal pancreas 18 months after a Whipple R0 procedure. CASE REPORT In September 2003, a 63-year-old man underwent a Whipple procedure with an extended lymphadenectomy, portal vein resection and direct reconstruction for pancreatic cancer. In September 2004, the tumor marker level increased and MR revealed a tumor in the remnant pancreas. There were no findings of invasion into the surrounding tissue or distant metastasis. After three months of systemic chemotherapy and a radiological reevaluation (PET and CT) in March 2005, we removed the remnant pancreas. Histopathologically, the tumor was classified as a ductal adenocarcinoma like the tumor which had been removed during the first operation, with infiltration of peripancreatic adipose tissue and a segmentary tract of the transverse mesocolon, without lymph node metastasis. CONCLUSIONS There are very few reports of pancreatic carcinoma recurrence in the remnant pancreas after a pancreaticoduodenectomy in the literature. In most of these cases, it is difficult to assess whether the remnant pancreatic cancer is a recurrence or a second primary cancer. In our patient, the first hypothesis seems to be more realistic due to the brief recurrence-free survival period. Otherwise the high rate of multicentricity in pancreatic cancer may also explain the development of a secondary cancer in the remnant pancreas, even though the interval was relatively brief.