Tsutsumi Chikanori, Abe Toshiya, Shinkawa Tomohiko, Nishihara Kazuyoshi, Tamiya Sadafumi, Nakano Toru
Department of Surgery, Kitakyushu Municipal Medical Center, 2-1-1 Bashaku, Kokurakita-Ku, Kitakyushu, 802-0077, Japan.
Department of Pathology, Kitakyushu Municipal Medical Center, Kitakyushu, Japan.
Surg Case Rep. 2020 Jul 3;6(1):157. doi: 10.1186/s40792-020-00924-8.
Pancreatic ductal adenocarcinoma (PDAC) is among the most aggressive malignancies. The prognosis for recurrence after surgery is extremely unfavorable, and liver metastasis of PDAC confers poor prognosis despite resection.
A 69-year-old man was admitted to our hospital for further examination and treatment, including surgery for a pancreatic tumor. On close inspection, he was suspected to have pancreatic head cancer without enlarged lymph nodes or distant metastasis, and pancreatoduodenectomy with D2 lymph node dissection was performed. A postoperative pathological examination revealed well-differentiated invasive ductal adenocarcinoma with lymph node metastasis (stage IIB; pT2N1M0). Postoperatively, he received adjuvant chemotherapy containing gemcitabine for 1 year. Eight years after the radical surgery, his serum carbohydrate antigen 19-9 level was elevated, and computed tomography (CT) and magnetic resonance imaging revealed a well-circumscribed 10-mm mass in liver segment 5. Positron emission tomography/CT also revealed high fluorine-18-fluorodeoxyglucose uptake only in this hepatic tumor. Accordingly, the patient was diagnosed with a solitary liver metastasis of PDAC. As the liver metastasis was isolated and identified long after the initial surgery, we decided to resect it using laparoscopic partial hepatectomy of segment 5. Histopathological examination confirmed liver metastasis of PDAC and the patient received adjuvant chemotherapy containing S-1. No evidence of recurrence has been seen for 11 years since the pancreatoduodenectomy and 3 years since the hepatic resection.
Cases of metachronous liver metastasis of PDAC after radical surgery, in which patients exhibit long-term survival without recurrence after hepatectomy, are extremely rare. Hepatectomy may confer long-term survival, and the time to postoperative recurrence and the number of liver metastases may be useful criteria for deciding whether to perform hepatic resection.
胰腺导管腺癌（PDAC）是侵袭性最强的恶性肿瘤之一。手术后复发的预后极差，尽管进行了切除，PDAC的肝转移仍预示着不良预后。
一名69岁男性因进一步检查和治疗入院，包括胰腺肿瘤手术。经仔细检查，怀疑他患有胰头癌，无淋巴结肿大或远处转移，遂行D2淋巴结清扫的胰十二指肠切除术。术后病理检查显示为高分化浸润性导管腺癌伴淋巴结转移（IIB期；pT2N1M0）。术后，他接受了含吉西他滨的辅助化疗1年。根治性手术后8年，他的血清糖类抗原19-9水平升高，计算机断层扫描（CT）和磁共振成像显示肝5段有一个边界清晰的10毫米肿块。正电子发射断层扫描/CT也显示仅在这个肝肿瘤中有高氟-18-氟脱氧葡萄糖摄取。因此，该患者被诊断为PDAC孤立性肝转移。由于肝转移是在初次手术后很长时间才被发现和确认的，我们决定采用腹腔镜肝5段部分切除术进行切除。组织病理学检查证实为PDAC肝转移，患者接受了含S-1的辅助化疗。自胰十二指肠切除术以来11年，自肝切除以来3年，均未见复发迹象。
根治性手术后发生PDAC异时性肝转移，肝切除术后患者长期生存且无复发的病例极为罕见。肝切除可能带来长期生存，术后复发时间和肝转移数量可能是决定是否进行肝切除的有用标准。
