Resection of residual pancreas six and a half years after whipple operation

R. X. Sousa Da Silva, M. Durband, R. Marti, O. Tschalèr, W. R. Marti

Objective

Pancreatic ductal adenocarcinoma has a poor overall survival rate. In the majority of cases it occurs in the pancreatic head and is resectable in curative intervention only in 15% to 20% percent of the cases. Standardised adjuvant chemotherapy with gemcitabine after a curative resection significantly improves the overall survival and the disease-free survival rates. However, most patients with a curative resection suffer from cancer recurrence within the first two post-operative years. If the recurrence is locally defined, resection of the residual pancreas improves the mean survival rate.

Methods

We describe a 54 year old female patient who underwent a duodenopancreatectomy six and a half years ago: now due to the emergence of a new pancreatic tumour, a resection of the residual pancreas combined with a splenectomy was performed.

Results

Six and a half years ago the patient suffered from epigastric pain. Diagnostic examination revealed strong suspicion of a locally defined pancreatic carcinoma in the pancreatic head. The patient underwent a Whipple operation and 6 cycles of chemotherapy with gemcitabine. The histopathological analysis showed a moderately differentiated pancreatic ductal adenocarcinoma.

Some weeks ago the patient presented herself with similar epigastric pain. Suspecting a cancer recurrence or a secondary pancreatic cancer, a computer tomography of the thorax and abdomen was made and a new tumour of 5 cm in size in the residual pancreas was detected. Further diagnostic examination showed no signs of metastasis. The patient then underwent a resection of the residual pancreas combined with a splenectomy. Histopathological analysis showed again a moderately differentiated pancreatic ductal adenocarcinoma.

Conclusion

This patient is a rare case of longer-term success of pancreatic ductal adenocarcinoma surgical therapy. The resection of the residual pancreas most likely increases the survival chances of this patient be it in terms of cancer recurrence or a secondary pancreatic cancer.