Background: Surgery for pancreatic cancer tends to be extensive and malnutrition due to postoperative stress, reduced exocrine pancreatic function, and impaired gastrointestinal function may affect the quality of life (QOL) of these patients.

Objective: To chronologically evaluate the association between postoperative nutritional status and QOL of pancreatic cancer patients and explore ways to improve QOL from a nutritional perspective.

Methods: Of 164 recruited patients who underwent surgery for pancreatic cancer, 65 completed preoperative, and 3- and 6-month postoperative nutritional assessment using the Controlling Nutritional Status (CONUT) score and assessment of health-related QOL using the Short Form-36 version 2 (SF-36v₂) Health Survey were included for statistical analysis of correlation between nutritional status and QOL.

Results: Pancreatic cancer patients tended to be malnourished before surgery and were generally malnourished 3 months after surgery. Specifically, patients in the pancreatoduodenectomy and total pancreatectomy groups remained malnourished up to 6 months after surgery. Malnutrition was correlated with the QOL domains "Physical Functioning", "Role-Physical", and "Social Functioning".

Conclusion: Malnutrition reduces QOL in patients with pancreatic cancer. Improving the nutritional status at 6 months after surgery could be a key to enhance overall QOL.

We report the case of a 63-year-old female admitted to our hospital with multiple pancreatic nodules detected by ultrasound during her medical examination. Computed tomography revealed three solid masses measuring 15mm, 20mm, and 30mm in diameter located at head, body, and tail of the pancreas.

She recelved a preliminary diagnosis of PNET from the prior institution which was hased on EUS-FNA cytology. Therefore, we conducted ⁶⁸Ga-DOTATOC-PET/CT, which showed abnormal uptake in each of the lesions of the pancreas. She underwent EUS-FNA biopsy for correct histological diagnosis after admission. The EUS-FNA specimen was marked with severe lymphocytes infiltration with strongly positive SSTR type 2 immunostaining. Neither PNET nor AIP-like lesions were noted histologically. We concluded a final diagnosis of mass-forming pancreatitis. Her follow-up has been uneventful and her pancreatic lesions remain unchanged.

A 46-year-old woman was referred to our hospital for a tumor detected in the pancreatic head. Endoscopic ultrasound-guided fine-needle aspiration yielded a diagnosis of unresectable pancreatic cancer with hepatic metastasis in the lateral segment (UR-M). After a complete response was achieved with 14 courses of FOLFIRINOX (fluorouracil, leucovorin, irinotecan, and oxaliplatin) therapy, she underwent subtotal stomach-preserving pancreaticoduodenectomy in combination with resection and reconstruction of the superior mesenteric vein, transverse colectomy, and S3 hepatic subsegmentectomy. Histopathological findings revealed replacement of the resection site tissue with a fibrous scar and the presence of only 2 atypical glands in the duodenal muscle layer. A margin-negative (R0) resection was achieved. To date, the patient has been alive without recurrence for 21 months, since treatment initiation, i.e., for 10 months after surgery. In recent years, there have been increasing reports of conversion surgery for unresectable pancreatic cancer, which is treated with radical resection after chemotherapy. Our case suggested that FOLFIRINOX therapy might permit conversion surgery for unresectable pancreatic cancer with distant metastases and improve its prognosis.

A 70-year-old man who had undergone left nephrectomy for renal cell carcinoma 20 years earlier was admitted for the treatment of hematuria. Contrast-enhanced computed tomography (CT) revealed a tumor in the pancreatic head. Cytological diagnosis was metastasis of renal clear cell carcinoma by EUS-FNA. He was referred to our department for surgical intervention. Dynamic CT showed a hypervascular lesion of 40mm in diameter at the pancreas head in the arterial phase and suspected intraductal growth into the main pancreatic duct. FDG-PET revealed high accumulation in the lesion (SUV max 6.56). The tumor was proximal to the superior mesenteric vein and tumor thrombus was also observed. The patient underwent subtotal stomach-preserving pancreatoduodenectomy with concomitant superior mesenteric vein resection. The pancreatic body was transected at the distal side of tumor extension, using intraoperative ultrasonography. We herein report this case because pancreatic metastasis of renal cell carcinoma with intraductal growth into the main pancreatic duct is very rare.

A 73-year-old male visited our hospital for the upper abdominal pain in June 2005. CT and MRI findings detected a 60-mm cystic tumor in the pancreatic head, and nodular lesions were observed in the dilated main pancreatic duct on magnetic resonance cholangiopancreatography. Endoscopic findings revealed mucinous secretion from the greater duodenal papilla. We conducted pylorus-preserving pancreaticoduodenectomy with a diagnosis of main pancreatic duct-type intraductal papillary-mucinous carcinoma (IPMC). In January 2008, a cystic lesion was discovered in the hepatorenal boundary by imaging performed during follow-up, and surgery was performed. The patient underwent laparotomy that revealed a jelly-like substance present on the lower surface of the liver, and was disposed of as most as possible. On histopathological examination, it was diagnosed as pseudomyxoma peritonei associated with IPMC of the pancreas. It recurred in the splenic hilar region in February 2010. Similar surgery was performed and as much as possible of the jelly-like material was excised. As of March 2017, more than 10 years since the initial surgery, no recurrent lesion has occurred and the patient remains alive.

Pancreatic metastasis is an uncommon and rare event for kidney cancer. However, it is said that despite being very few in number, the occurrence of any metastasis in pancreas originates primarily from kidney cancer.

The recurrence period in many reported cases is more than 10 years and long-term follow-up is necessary. We experienced 5 cases of resected pancreatic metastasis from renal cell carcinoma between 2008 and 2015. Of these, 3 cases consisted of multiple metastases. In all cases, dynamic CT showed high density tumors, which were enhanced in the early phase. We performed a radical surgery in all cases. Two of three cases received segmental pancreatectomies to preserve the pancreas as much as possible, and one of the multiple metastasis was total a pancreatectomy with total gastrectomy. There are various surgical options for the management of multiple pancreatic metastases. Some reports recommended, total pancreatectomy while others recommended segmental pancreatectomy. Careful consideration should be given when deciding the appropriate surgical course of action since preservation of organ function is essential.

A 69-year-old male was referred to our hospital because of mass detected in the pancreatic head. Contrast-enhanced CT scan showed a pancreatic head tumor, 30mm in diameter, which was hypo dense in early phase and hyper dense in delayed phase with central calcification, and cystic. An endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) was performed and the histological diagnosis of solid-pseudopapillary neoplasm (SPN) was confirmed by H&E and immunohistological stain. A pancreatoduodenectomy was therefore performed. SPN is relatively rare pancreatic tumor appearing most commonly in young females and calcification is often found in the margins of the tumor. Male cases of SPN are very rare and sometimes present different clinical findings from female cases. Therefore EUS-FNA is useful for the differential diagnosis of pancreatic tumor in such cases.

A 42-year-old man was admitted to our hospital because of suspicion of a tumor of the pancreatic body based on abdominal CT. He had no complaints. Blood biochemical, tumor marker, and pancreatic endocrine hormone testing yielded no abnormal findings. The tumor was strongly enhanced by abdominal contrast-enhanced CT and MRI. A pancreatic non-functional endocrine tumor was suspected, thus a distal pancreatectomy was performed. The histopathological diagnosis was solid type serous cystadenoma. We report a case of pancreatic solid type serous cystadenoma that was difficult to differentiate from a pancreatic neuroendocrine tumor.