Long-term survival after resection of pancreatic ductal adenocarcinoma with para-aortic lymph node metastasis: case report

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 diagno...

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Main Authors:	Masui, Toshihiko, Kubota, Toyonari, Aoki, Keiko, Nakanishi, Yasutaka, Miyamoto, Takumi, Nagata, Junko, Morino, Koshiro, Fukugaki, Atsushi, Takamura, Michio, Sugimoto, Shinichi, Onuma, Hideyuki, Tokuka, Atsuo
Format:	Online
Language:	English
Published:	BioMed Central 2013
Online Access:	https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3751482/

id	pubmed-3751482
recordtype	oai_dc
spelling	pubmed-37514822013-08-24 Long-term survival after resection of pancreatic ductal adenocarcinoma with para-aortic lymph node metastasis: case report Masui, Toshihiko Kubota, Toyonari Aoki, Keiko Nakanishi, Yasutaka Miyamoto, Takumi Nagata, Junko Morino, Koshiro Fukugaki, Atsushi Takamura, Michio Sugimoto, Shinichi Onuma, Hideyuki Tokuka, Atsuo Case Report 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. BioMed Central 2013-08-14 /pmc/articles/PMC3751482/ /pubmed/23945441 http://dx.doi.org/10.1186/1477-7819-11-195 Text en Copyright ©2013 Masui et al.; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/2.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
repository_type	Open Access Journal
institution_category	Foreign Institution
institution	US National Center for Biotechnology Information
building	NCBI PubMed
collection	Online Access
language	English
format	Online
author	Masui, Toshihiko Kubota, Toyonari Aoki, Keiko Nakanishi, Yasutaka Miyamoto, Takumi Nagata, Junko Morino, Koshiro Fukugaki, Atsushi Takamura, Michio Sugimoto, Shinichi Onuma, Hideyuki Tokuka, Atsuo
spellingShingle	Masui, Toshihiko Kubota, Toyonari Aoki, Keiko Nakanishi, Yasutaka Miyamoto, Takumi Nagata, Junko Morino, Koshiro Fukugaki, Atsushi Takamura, Michio Sugimoto, Shinichi Onuma, Hideyuki Tokuka, Atsuo Long-term survival after resection of pancreatic ductal adenocarcinoma with para-aortic lymph node metastasis: case report
author_facet	Masui, Toshihiko Kubota, Toyonari Aoki, Keiko Nakanishi, Yasutaka Miyamoto, Takumi Nagata, Junko Morino, Koshiro Fukugaki, Atsushi Takamura, Michio Sugimoto, Shinichi Onuma, Hideyuki Tokuka, Atsuo
author_sort	Masui, Toshihiko
title	Long-term survival after resection of pancreatic ductal adenocarcinoma with para-aortic lymph node metastasis: case report
title_short	Long-term survival after resection of pancreatic ductal adenocarcinoma with para-aortic lymph node metastasis: case report
title_full	Long-term survival after resection of pancreatic ductal adenocarcinoma with para-aortic lymph node metastasis: case report
title_fullStr	Long-term survival after resection of pancreatic ductal adenocarcinoma with para-aortic lymph node metastasis: case report
title_full_unstemmed	Long-term survival after resection of pancreatic ductal adenocarcinoma with para-aortic lymph node metastasis: case report
title_sort	long-term survival after resection of pancreatic ductal adenocarcinoma with para-aortic lymph node metastasis: case report
description	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.
publisher	BioMed Central
publishDate	2013
url	https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3751482/
_version_	1612005548925911040

Long-term survival after resection of pancreatic ductal adenocarcinoma with para-aortic lymph node metastasis: case report

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