In October 2003, a 78-year-old man underwent a distal pancreatectomy for invasive ductal carcinoma in the tail of the pancreas. After the operation, he received systemic chemotherapy based on gemcitabine (1,000 mg/m2/week for 3 months) and oral tegafur-uracil (300 mg/day for 57 months). He had no recurrence for 6 years after the initial operation. In November 2009, dynamic abdominal computed tomography (CT) scan revealed a 13 mm tumor with weak enhancement in the remnant pancreas. Adenocarci-noma was diagnosed by brushing cytology of the pancreatic duct and biopsy of the tumor under endo-scopic ultrasound-guided fine needle aspiration (EUS-FNA). Since there were no findings of other metas-tatic tumors, a total remnant pancreatectomy with portal vein resection and direct reconstruction was performed in December 2009. The histological findings yielded a diagnosis of metachronous pancreatic carcinoma, and not local recurrence because the disease-free span was much longer than the typical course of recurrence. The margin of the two surgical specimens were negative for carcinoma. Cura-tively resected metachronous invasive ductal carcinoma of the pancreatic head and the remnant pancreas is extremely rare. It is important to suspect metachronous cancer as well as recurrence in patients with secondary pancreatic tumor.
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