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. 2016 Dec;2(1):49.
doi: 10.1186/s40792-016-0177-y. Epub 2016 May 25.

Long-term survival with surgery for metachronous retroperitoneal lymph node and pancreatic metastases after curative resection of rectal cancer: a case report

Hitoshi Hino  1 , Hiroyasu Kagawa  2 , Yusuke Kinugasa  1 , Akio Shiomi  1 , Tomohiro Yamaguchi  1 , Yushi Yamakawa  1 , Masakatsu Numata  1 , Teiichi Sugiura  3 , Katsuhiko Uesaka  3
Affiliations

Long-term survival with surgery for metachronous retroperitoneal lymph node and pancreatic metastases after curative resection of rectal cancer: a case report

Hitoshi Hino et al. Surg Case Rep. 2016 Dec.

Abstract

Background: The possible benefits of the surgical resection of multiple metastases in rare sites from colorectal cancer (CRC) are still unclear. Therefore, more cases are needed to investigate the surgical outcomes of these diseases. A very rare case in which the simultaneous resection of both the metachronous retroperitoneal lymph node and pancreatic metastases from rectal cancer was successfully performed is reported.

Case presentation: A 68-year-old man had undergone low anterior resection for rectal cancer. Eight months later, computed tomography showed an enlarged lymph node located below the aortic bifurcation and a pancreatic head tumor. Positron emission tomography showed increased focal uptake in these two lesions. With a diagnosis of retroperitoneal lymph node metastasis from rectal cancer and primary pancreatic cancer or pancreatic metastasis from rectal cancer, resection of the enlarged retroperitoneal lymph node and pancreaticoduodenectomy were performed. The pathological examination showed that both resected lesions were metastases from the primary rectal cancer. After the metastasectomy, the patient was given systemic chemotherapy, which was discontinued due to an adverse event. He was then followed up routinely without any medication. Sixty-nine months after the metastasectomy, he is alive without any indication of recurrence.

Conclusions: Thus, even with metastases from CRC located in rare sites, an acceptable outcome can be expected following curative surgical resection in carefully selected patients. Whenever possible, an aggressive surgical approach should be included in the multimodality treatment of metastatic CRC.

Keywords: Pancreatic metastasis; Rectal cancer; Recurrence; Retroperitoneal lymph node metastasis; Surgery.

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Figures

Fig. 1
Fig. 1
Macroscopic findings of the primary rectal cancer. A type 2 tumor (40 × 50 mm) is seen in the resected rectum
Fig. 2
Fig. 2
Preoperative findings of abdominal contrast CT. a An enlarged retroperitoneal lymph node (28 mm in diameter) is confirmed below the aortic bifurcation (arrow). b A hypovascular tumor (25 mm in diameter), which was growing invasively, is shown in the head of the pancreas (arrow)
Fig. 3
Fig. 3
Preoperative findings of 18FDG-PET. The enlarged retroperitoneal lymph node has a maximum standardized uptake value (SUV max) of 6.08 (arrow head), and the pancreatic tumor has an SUV max of 7.83 (arrow)
Fig. 4
Fig. 4
Pathological findings of resected tumors. a Pathological findings of the retroperitoneal lymph node (H&E). b Pathological findings of the pancreatic tumor (H&E). c Pathological findings of the primary rectal cancer (H&E). Bar: 1 mm. On pathology, both the retroperitoneal lymph node and pancreatic tumors show adenocarcinoma, identical to the primary rectal cancer and compatible with metastases of the rectal cancer. d Positive immunohistochemical staining for CDX-2 in the pancreatic tumor
See this image and copyright information in PMC

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