Is total pancreatectomy for ductal adenocarcinoma of the head of the pancreas justified based on the risk of tumor multicentricity?

The Aim. Study of a clinical case of metachronous primary multiple cancer of the head of the pancreas and liver.Materials and methods. The work was carried out with modern domestic and foreign literature sources devoted to the problem of primary multiple malignant neoplasms. A retrospective analysis of the patient’s clinical and anamnestic data was performed, the necessary medical documentation was studied.Results. In 2011, a pancreatoduodenal resection was performed on a patient for ductal adenocarcinoma of the head of the pancreas. In 2021, an MRI scan revealed a formation in S5-S6 with dimensions up to 34x35x29 mm. According to the histological examination of the biopsy material, hepatocellular carcinoma was conﬁrmed. Resection of the 5th segment of the liver was performed in the conditions of the NMIC Oncology in Rostov-on-Don.Conclusion. The presented case of primary multiple cancer of the head of the pancreas and hepatocellular carcinoma of the liver is of direct interest both from the point of view of oncological surgery and chemotherapy.

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Is there a role for total pancreatectomy in pancreatic ductal adenocarcinoma?

Gastroenterology ◽

10.1016/0016-5085(82)90332-8 ◽

1982 ◽

Vol 82 (4) ◽

pp. 812

Author(s):

R.S. Jones

Keyword(s):

Pancreatic Ductal Adenocarcinoma ◽

Total Pancreatectomy ◽

Ductal Adenocarcinoma

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Total Pancreatectomy for Malignant Intraductal Papillary Mucinous Neoplasm (IPMN) Complicated by Gastropancreatic Fistulae

Case Reports in Surgery ◽

10.1155/2020/8547526 ◽

2020 ◽

Vol 2020 ◽

pp. 1-4

Author(s):

Oshan Basnayake ◽

Pradeep Wijerathne ◽

Umesh Jayarajah ◽

Nilesh Fernandopulle ◽

Sivasuriya Sivaganesh

Keyword(s):

Intraductal Papillary Mucinous Neoplasm ◽

Total Pancreatectomy ◽

Epigastric Pain ◽

Past History ◽

Ductal Adenocarcinoma ◽

Fistula Formation ◽

Oral Contrast ◽

High Grade ◽

Recurrent Acute Pancreatitis ◽

Mucinous Neoplasm

Background. Intraductal papillary mucinous neoplasms (IPMN) of the pancreas complicated by fistula formation to adjacent organs are an uncommon phenomenon. We present an IPMN of the pancreas with malignant transformation and multiple fistulae to the stomach and duodenum. Case Presentation. A 50-year-old female was referred for investigation of recent epigastric pain and a past history of recurrent pancreatitis. Imaging with computed tomography showed a gross dilatation of the entire pancreatic duct with a heterogeneous enhancement of the periductal parenchyma. A passage of oral contrast was noted from the greater curvature and pylorus of the stomach into the dilated duct suggestive of fistulae formation. Gastroduodenoscopy demonstrated these fistulae in the stomach and the proximal duodenum and an exophytic growth at the ampulla obliterating the view of ampullary opening. Endosonography- (EUS-) guided fine-needle aspiration cytology (FNAC) showed cells with high-grade atypia. A total pancreatectomy, distal gastrectomy, and splenectomy were performed, and recovery was uneventful. Histology revealed a ductal adenocarcinoma arising from an intestinal type intraductal papillary mucinous neoplasm with high-grade dysplasia. A year and a half after surgery, she is healthy with good glycaemic control and nutritional status. Conclusion. This case highlights the importance investigating patients for the aetiology in recurrent acute pancreatitis and their follow-up. Awareness of cystic pancreatic neoplasms including IPMN is important to avoid misdiagnosis or delayed diagnosis. Referral of these patients to centres with facilities for multidisciplinary input and specialised management is strongly recommended.

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