Is a patient with metastatic pancreatic tumor from rectal cancer a candidate for resection?

A 54-year-old man who had undergone Miles' operation for rectal cancer in 1999 was found to have four brain metastases, which were treated by partial resection and gamma knife therapy in February 2003. During follow-up, ultrasound (US) showed a hypoechoic lesion in the head of the pancreas, and computed tomography (CT) demonstrated low-density tumors in the pancreatic head and left adrenal gland. Endoscopic retrograde pancreatography revealed severe stenosis of the main pancreatic duct, and endoscopic ultrasonography showed a hypoechoic lesion in the pancreas head. This patient was also found to have a coin lesion in the middle of the right lung by chest CT. All lesions were considered resectable. The patient underwent pancreato-duodenectomy and left adrenectomy. Histologically, these tumors were diagnosed as metastases from the rectal cancer. Although the patient's postoperative course was uneventful, CT showed multiple metastases in the both lungs. These were not resectable, and the patient died eight months after surgery. In summary, patients with metastases from rectal cancer to multiple organs, including the pancreas, may not be candidates for pancreatic resection.