Abstract
Pancreatic cancer patients with para-aortic lymph node metastasis have a poor prognosis and patients living longer than 3 years are rare. We had a patient with pancreatic cancer who survived for more than 10 years after removal of the para-aortic lymph node metastasis. A 57-year-old woman was diagnosed with pancreatic head cancer and underwent a pancreaticoduodenectomy with subtotal gastric resection following Whipple reconstruction in 2000. Para-aortic lymph node metastasis was detected during the operation by intraoperative pathological diagnosis and an extended lymphadenectomy was performed with vascular skeletonization of the celiac and superior mesenteric arteries. In 2004, a low-density area was detected around the superior mesenteric artery (SMA) 5 cm from its root and she was treated with gemcitabine, and the area was undetectable after 3 years of treatment. In 2010, computed tomography showed a low-density area around the same lesion with an increased carcinoembryonic antigen level. After 4 months of gemcitabine treatment, we resected the tumor en bloc with the associated superior mesenteric vein and perineural tissue. Histopathological examination of the resected specimen revealed a well-differentiated tubular adenocarcinoma that closely resembled the original primary pancreatic cancer, indicating perineural recurrence 10 years after the initial resection. She had no recurrence around the SMA for more than one year. Although a meta-analysis has not proved the efficacy of preventive radical dissection, this case indicates that a patient with well-differentiated, chemotherapy-responsive pancreatic cancer with para-aortic lymph node metastasis could have a long survival time through extended dissection of the lymph nodes.
Highlights
Pancreatic cancer is among the leading causes of cancer death in Japan and worldwide
We report the case of a patient who survived for more than 10 years after pancreaticoduodenectomy for pancreatic cancer with para-aortic lymph node metastasis
We assume that the long survival time is due to the characteristics of the tumor and the extent of the operation: (1) the original tumor was a well-differentiated adenocarcinoma, (2) it showed good response to chemotherapy and (3) an extended lymphadenectomy was performed, which achived a negative margin status
Summary
Pancreatic cancer is among the leading causes of cancer death in Japan and worldwide. Several previous reports have indicated a median survival time (MST) of 5 to 12 months after resection in metastatic para-aortic lymph node patients (Table 1). In 2004, CT examination revealed a low-density area around the superior mesenteric artery (SMA) 5 cm from its root, suggesting lymph node metastasis (Figure 2a). She was treated with gemcitabine for 3 years. In August 2010, a routine CT examination displayed a low-density area around the SMA (Figure 2c) with a CEA level above the reference range (13 U/ml) We treated her with gemcitabine for 4 months, and no other metastases were found. Histopathological examination of the resected specimen revealed a well-differentiated tubular adenocarcinoma very similar to the primitive pancreatic cancer (Figure 1d). The patient was recurrence free for more than 1 year
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