[Carcinoma of the pancreatic remnant developing after pancreaticoduodenectomy for adenocarcinoma of the head of pancreas].

In November 1996 a 44-year-old man with an adenocarcinoma of the pancreatic head (T2 N1 Mx- UICC 1998 Stage III) underwent a Traverso-Longmire pancreaticoduodenectomy. Early reoperation was required owing to postoperative acute pancreatitis and haemorrhage of the pancreatic remnant, after which he received chemo- and radiotherapy. Twenty-nine months later, an increase in the level of CA19.9 was observed with neither clinical nor radiological evidence of cancer recurrence. Forty months later, there was evidence of a new neoplasia of the pancreatic remnant. Since the recurrence involved only the pancreatic remnant with no evidence of metastases and the patient was in good condition and enough time had elapsed since surgical eradication of the primary cancer, we decided to perform an en bloc resection of the pancreatic body and tail and the spleen. Histologically, the tumour proved to be a pancreatic adenocarcinoma (T2). It is difficult to assess whether this cancer of the pancreatic remnant was a recurrence or a second primary cancer because of the long recurrence-free survival period, the absence of neoplastic invasion of the resection margins of the two surgical specimens and the absence of multicentricity both of the portion of the gland removed by the first operation and that removed by the second.