Salvage pancreaticoduodenectomy for localized recurrence after resection of ascending colon cancer: a case report.
Rihito Nagata, Nobuyuki Takemura, Masahiko Komagome et al.
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Case in brief
A 66-year-old man underwent right hemicolectomy for ascending colon cancer directly invading the gallbladder; pathology showed T4bN0M0, Stage IIC disease with a KRAS G12D mutation. Four months later, imaging identified an approximately 3-cm localized recurrence involving the duodenum and ileum, without distant metastasis. After two cycles of chemotherapy, the tumor had shrunk, and he underwent pancreaticoduodenectomy with resection of involved ileum and a short segment of transverse colon. Pathology showed adenocarcinoma crossing the duodenum–ileum adhesion plane and infiltrating both bowel walls, consistent with origin at the initial dissection plane. He received no postoperative chemotherapy by choice and remained disease-free for more than 7 years.
What made this case unusual
The recurrence infiltrated the muscularis propria of both the duodenum and ileum across their adhesion plane, without exposing tumor to either intestinal lumen; pathology suggested residual cancer cells at the original surgical dissection plane.
Diagnostic / clinical pearl
A localized recurrence involving adjacent bowel may extend across an adhesion plane without intraluminal exposure; examination of the resection specimen can help identify its likely relationship to the prior operative dissection plane.