Hirai Kenjiro, Takeshima Jun, Ichikawa Jun, Okabe Asami, Ohe Hidenori, Mitsuyoshi Akira
Department of Surgery, Japanese Red Cross Otsu Hospital, 1-1-35 Nagara, Otsu City, Siga 520-8511, Japan; Department of Surgery, Otsu City Hospital, 2-9-9 Motomiya, Otsu city, Shiga 520-0804, Japan.
Department of Surgery, Otsu City Hospital, 2-9-9 Motomiya, Otsu city, Shiga 520-0804, Japan.
Int J Surg Case Rep. 2023 Sep;110:108724. doi: 10.1016/j.ijscr.2023.108724. Epub 2023 Aug 30.
Reports on lung resection for recurrence with lung metastases after the surgical treatment of pancreatic cancer have been sporadic, and limited information is currently available on the long-term postoperative course. Furthermore, the significance of the surgical resection of recurrent/metastatic lesions after the resection of pancreatic cancer has not been sufficiently established. We herein present a long-term recurrence-free survivor after perioperative chemotherapy and pancreatic resection for primary pancreatic body cancer who underwent resection for isolated lung metastases twice.
A 66-year-old woman with locally advanced pancreatic cancer accompanied by invasion of the splenic artery underwent distal pancreatectomy with celiac axis resection following preoperative S1 + gemcitabine therapy. Recurrence with lung metastasis was detected 42 and 62 months after resection of the primary lesion, and lung resection was performed both times. As postoperative adjuvant therapies, S1 + gemcitabine therapy was performed after lung resection. The patient has survived free of recurrence for 11 years after resection of the primary lesion and 5 years and 9 months after the second lung resection.
A long interval from resection of the primary lesion to the occurrence of lung metastases and the high responsiveness of the patient to chemotherapy may have contributed to her long-term survival.
This case suggests that if lung metastasis occurring after radical resection of the primary lesion is resected without remnants, aggressive multidisciplinary treatment, including surgical resection with the appropriate selection of cases, may contribute to improvements in patient outcomes.
关于胰腺癌手术治疗后肺转移复发行肺切除的报道较为零散，目前关于术后长期病程的信息有限。此外，胰腺癌切除术后复发性/转移性病变手术切除的意义尚未得到充分证实。在此，我们报告一例接受围手术期化疗和胰腺切除术治疗原发性胰体癌的患者，该患者两次接受孤立性肺转移灶切除术，实现了长期无复发生存。
一名66岁女性，患有局部晚期胰腺癌并侵犯脾动脉，术前接受S1+吉西他滨治疗后行远端胰腺切除术并切除腹腔干。在原发性病变切除后42个月和62个月检测到肺转移复发，两次均进行了肺切除术。作为术后辅助治疗，肺切除术后进行了S1+吉西他滨治疗。该患者在原发性病变切除后已无复发生存11年，在第二次肺切除后已无复发生存5年9个月。
从原发性病变切除到发生肺转移的间隔时间较长以及患者对化疗的高反应性可能是其长期生存的原因。
该病例表明，如果在原发性病变根治性切除后发生的肺转移灶能够完整切除，积极的多学科治疗，包括适当选择病例进行手术切除，可能有助于改善患者预后。
