A resected case of pancreatic head cancer developing 40 years after lateral pancreaticojejunostomy for chronic pancreatitis

Sep 22, 2026

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A 72-year-old male presented with upper abdominal pain and jaundice and had undergone a side-to-side pancreaticojejunostomy 40 years earlier for chronic pancreatitis. Workup identified a 3 cm pancreatic head tumor as the jaundice etiology, leading to a diagnosis of resectable pancreatic cancer. After two cycles of neoadjuvant chemotherapy, an extended pancreatoduodenectomy was performed for tumor invasion at the prior anastomosis, with portal vein resection and reconstruction. Pathology confirmed invasive ductal carcinoma (T2N1M0, Stage IIB), highlighting delayed cancer risk even after long-term follow-up post-surgery.

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CategoryHealthcare

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Clinical Journal of Gastroenterology (2024) 17:537–542 [https://doi.org/10.1007/s12328-024-01924-z](https://doi.org/10.1007/s12328-024-01924-z) A resected case of pancreatic head cancer developing 40 years after lateral pancreaticojejunostomy for chronic pancreatitis Takatsugu Matsumoto1 · Genki Tanaka1 · Shozo Mori1 · Maiko Niki1 · Shun Sato1 · Takayuki Shiraki1 · Yukihiro Iso1 · Kazunori Nagashima2 · Atsushi Irisawa2 · Yumi Nozawa3 · Atsuko Takada‑Owada3 · Kazuyuki Ishida3 · Taku Aoki1 Received: 8 November 2023 / Accepted: 11 January 2024 / Published online: 24 February 2024 © The Author(s) 2024 Abstract A 72-year-old male patient presented to our department complaining of with upper abdominal pain and jaundice. He had a history of a side-to-side pancreaticojejunostomy performed 40 years previously for chronic pancreatitis. A diagnostic workup revealed a tumor 3 cm in size in the pancreatic head as the etiology of the jaundice. Subsequently, the patient was diagnosed with resectable pancreatic cancer. Following two cycles of neoadjuvant chemotherapy, an extended pancreatoduodenectomy was performed because of tumor invasion at the previous pancreaticojejunostomy site. Concurrent portal vein resection and reconstruction were performed. Pathological examination confirmed invasive ductal carcinoma (T2N1M0, Stage IIB) . This case highlights the clinical challenges in pancreatic head carcinoma following a side-to-side pancreaticojejunostomy. Although pancreaticojejunostomy is believed to reduce the risk of pancreatic cancer in patients with chronic pancreatitis, clinicians should be aware that, even after this surgery, there is still a chance of developing pancreatic cancer during longterm follow-up. Keywords Pancreaticojejunostomy · Pancreatic head carcinoma · Resectable pancreatic cancer Introduction Pancreatic cancer (PC) is the fourth leading cause of cancerrelated death in the United States, with an overall survival rate of only 6% . Moreover, it is projected to become the country’s second-leading cause of cancer-related deaths by 2030 [1] . Surgical resection is currently the only curative option; however, only 20% of PCs are surgically resectable at diagnosis [2]. Chronic pancreatitis (CP), which is characterized by long-standing pancreatic inflammation, has been identified as an important risk factor for the development of pancreatic cancer [3] . The incidence of PC in patients with CP has been reported to be as high as 7.6‒68.1 times * Takatsugu Matsumoto [t-matsu@dokkyomed.ac.jp](t-matsu@dokkyomed.ac.jp) 1 Department of Hepato-Biliary-Pancreatic Surgery, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Tochigi 321-0293, Japan 2 Department of Gastroenterology, Dokkyo Medical University, Mibu, Tochigi, Japan 3 Department of Diagnostic Pathology, Dokkyo Medical University, Mibu, Tochigi, Japan [4] . The risk has been reported with varying results across different study populations. Cumulative incidences of PC among newly diagnosed CP patients have been reported to range from 0.24 to 5.7%[4–7] . In a long-term prospective observational study of patients with chronic pancreatitis conducted by Malka et al., the incidence of pancreatic cancer in patients with chronic pancreatitis was 1.1%, with a remarkably high age-and sex-standardized incidence ratio of 26.7 times that of the National Cancer Register in France [4] . Surgical interventions for chronic pancreatitis, particularly pancreaticojejunostomy, are recognized for mitigating chronic pain and potentially reducing the long-term pancreatic cancer risk by alleviating chronic inflammation [8, 9] . Herein, we present an unusual case of pancreatic cancer that developed 40 years after a side-to-side pancreaticojejunostomy for chronic pancreatitis. Case presentation A 72-year-old male patient presenting with upper abdominal pain and jaundice was referred to our department for further review. Four decades earlier, the patient underwent a side-t

FAQs

What symptoms prompted the patient’s presentation?

Upper abdominal pain and jaundice led to referral for further evaluation.

What past treatment was the patient known to have had?

He had a side-to-side pancreaticojejunostomy performed 40 years earlier for chronic pancreatitis.

How was the pancreatic cancer treated after diagnosis?

The patient received two cycles of neoadjuvant chemotherapy, followed by an extended pancreatoduodenectomy with portal vein resection and reconstruction due to invasion at the previous anastomosis.

Sep 22, 2026

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