Ressection of pancreatic carcinoma in the remnant pancreas after an R0 pancreaticoduodenectomy for papillary cancer: a case report

Abstract

Introduction: We report a rare case of a repeated pancreatic resection in the remnant distal pancreas 18 months after a laparoscopic Whipple R0 procedure. In this case, the first surgery was for papillary cancer. Method: In February 2014, a 73-year-old woman underwent a laparoscopic Pancreatoduodenectomy procedure with lymphadenectomy for papillary cancer. In August 2015, in follow up segment MR revealed a tumor in the remnant pancreas. There were no findings of invasion of the surrounding tissue or distant metastasis. After radiological reevaluation (PET and CT) in October 2015, we removed the remnant pancreas and spleen also by laparoscopic surgery. Results: Histopathologically, the tumor was classified as a ductal adenocarcinoma, not the same tumor which had been removed during the first operation, with infiltration of peripancreatic adipose tissue and without lymph node metastasis. She was using Capecitabin after the surgery and in august 2016 peritoneal metastasis apears and died in september 2017. We compare the two histophatological diagnoses. Conclusions: There are very few reports of pancreatic carcinoma in the remnant pancreas after a pancreaticoduodenectomy in the literature. In most of these cases, it is for adenocarcinoma and even so 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 a new tumor.