Journal of the Pancreas Open Access

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Unresectable Pancreatic Ductal Adenocarcinoma in the Remnant Pancreas Diagnosed during Every-6-Month Surveillance after Resection of Branch Duct Intraductal Papillary Mucinous Neoplasm: A Case Report

Toshihisa Tamura, Takao Ohtsuka, Noboru Ideno, Teppei Aso, Hiroshi Kono, Yousuke Nagayoshi, Koji Shindo, Yasuhiro Ushijima, Junji Ueda, Shunichi Takahata, Tetsuhide Ito, Yoshinao Oda, Kazuhiro Mizumoto, Masao Tanaka

Context There are few studies regarding the surveillance period and interval of resected or observed branch duct intraductalpapillary mucinous neoplasms (IPMNs) of the pancreas in terms of early detection of concomitant pancreatic ductaladenocarcinoma. Despite a strict surveillance protocol, some patients are diagnosed with metastatic distinct ductaladenocarcinoma after resection of IPMN. Case report We herein report a patient with unresectable pancreatic ductaladenocarcinoma that developed in the remnant pancreas 18 months after resection of branch duct IPMN. Although thepatient was surveyed every 6 months after the operation and imaging studies at 6 and 12 months postoperativelydemonstrated no evidence of recurrence, invasive ductal adenocarcinoma with liver metastasis appeared 18 months afterthe operation. The patient subsequently underwent chemotherapy; however, he died 9 months after the diagnosis ofmetachronous pancreatic ductal adenocarcinoma. Conclusions In some patients with branch duct IPMNs, 6-monthsurveillance seems to be insufficient to detect resectable concomitant pancreatic ductal adenocarcinoma. Therefore,identification of high-risk patients who require surveillance at shorter intervals is urgently needed.