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Curative resection after chemotherapy and chemoradiotherapy for postoperative recurrence of pancreatic tail cancer in the abdominal wall: a case report

BACKGROUND: Locoregional recurrence and metastasis to the liver, peritoneum, and lung are the most common recurrent patterns of pancreatic ductal adenocarcinoma (PDAC) after radical resection. Recurrence in the abdominal wall is extremely rare. Herein, we report our experience with a patient who had...

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Autores principales: Iio, Shunya, Hozaka, Yuto, Tanoue, Kiyonori, Idichi, Tetsuya, Fukuda, Kousuke, Nakashima, Taiki, Yasudome, Ryutaro, Yamasaki, Yoichi, Kawasaki, Yota, Arigami, Takaaki, Nakajo, Akihiro, Higashi, Michiyo, Mataki, Yuko, Kurahara, Hiroshi, Ohtsuka, Takao
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer Berlin Heidelberg 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9117584/
https://www.ncbi.nlm.nih.gov/pubmed/35585274
http://dx.doi.org/10.1186/s40792-022-01452-3
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author Iio, Shunya
Hozaka, Yuto
Tanoue, Kiyonori
Idichi, Tetsuya
Fukuda, Kousuke
Nakashima, Taiki
Yasudome, Ryutaro
Yamasaki, Yoichi
Kawasaki, Yota
Arigami, Takaaki
Nakajo, Akihiro
Higashi, Michiyo
Mataki, Yuko
Kurahara, Hiroshi
Ohtsuka, Takao
author_facet Iio, Shunya
Hozaka, Yuto
Tanoue, Kiyonori
Idichi, Tetsuya
Fukuda, Kousuke
Nakashima, Taiki
Yasudome, Ryutaro
Yamasaki, Yoichi
Kawasaki, Yota
Arigami, Takaaki
Nakajo, Akihiro
Higashi, Michiyo
Mataki, Yuko
Kurahara, Hiroshi
Ohtsuka, Takao
author_sort Iio, Shunya
collection PubMed
description BACKGROUND: Locoregional recurrence and metastasis to the liver, peritoneum, and lung are the most common recurrent patterns of pancreatic ductal adenocarcinoma (PDAC) after radical resection. Recurrence in the abdominal wall is extremely rare. Herein, we report our experience with a patient who had recurrent PDAC in the abdominal wall with long-term survival by means of multidisciplinary therapy. CASE PRESENTATION: A 76-year-old Japanese woman was diagnosed with resectable pancreatic tail cancer. She underwent distal pancreatectomy with regional lymphadenectomy after two cycles of gemcitabine plus S-1 as neoadjuvant therapy. She also received eight cycles of S-1 as adjuvant chemotherapy. Approximately 14 months after the initial surgery, imaging examinations identified a mass suggesting recurrence in the abdominal wall at the middle wound that involved the transverse colon. After two cycles of gemcitabine plus nab-paclitaxel, chemoradiotherapy (S-1 plus 45 Gy) and seven cycles of modified FOLFIRINOX (5-fluorouracil/leucovorin, irinotecan, and oxaliplatin) were administered. The patient did not develop any new recurrent lesions during chemotherapy and chemoradiotherapy. Therefore, the recurrent lesion in the abdominal wall and the involved transverse colon were resected. We confirmed the lack of peritoneal dissemination during surgery. Pathological examination revealed that the resected lesion was metastasis of primary PDAC, and the surgical margin was 1 mm. However, re-recurrence localized in the abdominal wall was detected 9 months later. The re-recurrent lesion was diagnosed as local recurrence of the first recurrent lesion. We performed a second resection of the abdominal wall using a femoral myocutaneous flap to achieve sufficient surgical margin. The pathological findings of the resected specimen were the same as those of the previous specimens, and the resection margin was negative. The patient’s postoperative course was uneventful. Seven years after the initial surgery and 3 years and 7 months after the third surgery, the patient is alive with no signs of recurrence. CONCLUSIONS: Long-term survival could be achieved by radical resection with sufficient surgical margins for recurrence of PDAC in the abdominal wall if new other recurrent lesions, including peritoneal dissemination, are prevented through chemotherapy.
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spelling pubmed-91175842022-05-20 Curative resection after chemotherapy and chemoradiotherapy for postoperative recurrence of pancreatic tail cancer in the abdominal wall: a case report Iio, Shunya Hozaka, Yuto Tanoue, Kiyonori Idichi, Tetsuya Fukuda, Kousuke Nakashima, Taiki Yasudome, Ryutaro Yamasaki, Yoichi Kawasaki, Yota Arigami, Takaaki Nakajo, Akihiro Higashi, Michiyo Mataki, Yuko Kurahara, Hiroshi Ohtsuka, Takao Surg Case Rep Case Report BACKGROUND: Locoregional recurrence and metastasis to the liver, peritoneum, and lung are the most common recurrent patterns of pancreatic ductal adenocarcinoma (PDAC) after radical resection. Recurrence in the abdominal wall is extremely rare. Herein, we report our experience with a patient who had recurrent PDAC in the abdominal wall with long-term survival by means of multidisciplinary therapy. CASE PRESENTATION: A 76-year-old Japanese woman was diagnosed with resectable pancreatic tail cancer. She underwent distal pancreatectomy with regional lymphadenectomy after two cycles of gemcitabine plus S-1 as neoadjuvant therapy. She also received eight cycles of S-1 as adjuvant chemotherapy. Approximately 14 months after the initial surgery, imaging examinations identified a mass suggesting recurrence in the abdominal wall at the middle wound that involved the transverse colon. After two cycles of gemcitabine plus nab-paclitaxel, chemoradiotherapy (S-1 plus 45 Gy) and seven cycles of modified FOLFIRINOX (5-fluorouracil/leucovorin, irinotecan, and oxaliplatin) were administered. The patient did not develop any new recurrent lesions during chemotherapy and chemoradiotherapy. Therefore, the recurrent lesion in the abdominal wall and the involved transverse colon were resected. We confirmed the lack of peritoneal dissemination during surgery. Pathological examination revealed that the resected lesion was metastasis of primary PDAC, and the surgical margin was 1 mm. However, re-recurrence localized in the abdominal wall was detected 9 months later. The re-recurrent lesion was diagnosed as local recurrence of the first recurrent lesion. We performed a second resection of the abdominal wall using a femoral myocutaneous flap to achieve sufficient surgical margin. The pathological findings of the resected specimen were the same as those of the previous specimens, and the resection margin was negative. The patient’s postoperative course was uneventful. Seven years after the initial surgery and 3 years and 7 months after the third surgery, the patient is alive with no signs of recurrence. CONCLUSIONS: Long-term survival could be achieved by radical resection with sufficient surgical margins for recurrence of PDAC in the abdominal wall if new other recurrent lesions, including peritoneal dissemination, are prevented through chemotherapy. Springer Berlin Heidelberg 2022-05-19 /pmc/articles/PMC9117584/ /pubmed/35585274 http://dx.doi.org/10.1186/s40792-022-01452-3 Text en © The Author(s) 2022 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) .
spellingShingle Case Report
Iio, Shunya
Hozaka, Yuto
Tanoue, Kiyonori
Idichi, Tetsuya
Fukuda, Kousuke
Nakashima, Taiki
Yasudome, Ryutaro
Yamasaki, Yoichi
Kawasaki, Yota
Arigami, Takaaki
Nakajo, Akihiro
Higashi, Michiyo
Mataki, Yuko
Kurahara, Hiroshi
Ohtsuka, Takao
Curative resection after chemotherapy and chemoradiotherapy for postoperative recurrence of pancreatic tail cancer in the abdominal wall: a case report
title Curative resection after chemotherapy and chemoradiotherapy for postoperative recurrence of pancreatic tail cancer in the abdominal wall: a case report
title_full Curative resection after chemotherapy and chemoradiotherapy for postoperative recurrence of pancreatic tail cancer in the abdominal wall: a case report
title_fullStr Curative resection after chemotherapy and chemoradiotherapy for postoperative recurrence of pancreatic tail cancer in the abdominal wall: a case report
title_full_unstemmed Curative resection after chemotherapy and chemoradiotherapy for postoperative recurrence of pancreatic tail cancer in the abdominal wall: a case report
title_short Curative resection after chemotherapy and chemoradiotherapy for postoperative recurrence of pancreatic tail cancer in the abdominal wall: a case report
title_sort curative resection after chemotherapy and chemoradiotherapy for postoperative recurrence of pancreatic tail cancer in the abdominal wall: a case report
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9117584/
https://www.ncbi.nlm.nih.gov/pubmed/35585274
http://dx.doi.org/10.1186/s40792-022-01452-3
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