2019 Volume 44 Issue 2 Pages 209-216
The patient was a 70-year-old man. During follow-up for chronic pancreatitis, he was found to have branch-duct intraductal papillary mucinous neoplasm (IPMN) in the head of the pancreas. In accordance with the cyst size and presence of an internal solid component, subtotal stomach-preserving pancreaticoduodenectomy with pancreatogastrostomy was performed. The lesion was diagnosed by histopathology as an IPMN. Upper gastrointestinal endoscopy performed 2 years after the surgery revealed a submucosal 0-I tumor measuring approximately 30 mm in diameter in the posterior wall of the middle part of the gastric corpus, which was diagnosed by biopsy as an adenocarcinoma. Findings of upper gastrointestinal endoscopy and computed tomography indicated that the pancreas-stomach anastomosis and type 0-I tumor were separated by a distance of 3 cm by intervening normal mucosa; the tumor was thus diagnosed as a remnant gastric cancer, and local resection was performed. The patient has been followed up without recurrence for 5 years after the pancreaticoduodenectomy and 3 years after the local gastric resection. Although long-term survival can be expected in patients with IPMN after pancreaticoduodenectomy, some cases of newly occurring metachronous multiple primary cancer in the residual stomach have been reported. Therefore, careful postoperative follow-up focusing on the residual stomach is important.
