Long-Term Survival after Resection of Pancreatic Ductal Adenocarcinoma with Late Metachronous Pulmonary Metastasectomy

Objective Pancreatic ductal adenocarcinoma has a five year survival rate of 20% following radical surgical resection. The aggressive tumor biology and heterogenous nature of pancreatic ductal adenocarcinoma results in metastatic spread which further decreases overall survival. We report a patient who successfully underwent a pulmonary metastasectomy five years after the resection of a pancreatic ductal adenocarcinoma originating from an intraductal papillary mucinous neoplasm. Case report A sixty-one-year-old male underwent a pancreaticoduodenectomy with vein resection for a locally advanced pancreatic ductal adenocarcinoma. The origin of the tumor was from an intraductal papillary mucinous neoplasm. The patient had an uneventful recovery and follow up showed no sign of disease recurrence. Five years after the primary resection, the patient experienced rapid weight loss despite adequate nutrition. A computed tomography scan revealed a 22 x 16 mm lesion in the upper lobe of the left lung. The patient underwent a thoracoscopic resection of the lesion and histology confirmed this to be a metastasis from the primary pancreatic ductal adenocarcinoma. A period of eight years has passed since the primary resection and the patient continues to do well. Conclusion We here present a case of long term survival of a patient who underwent a metachronous pulmonary metastasectomy after pancreatic resection for a pancreatic ductal adenocarcinoma originating from an intraductal papillary mucinous neoplasm. This highlights the fact that selected patients may benefit from resection of solitary pulmonary metastasis of pancreatic ductal adenocarcinoma. While this adds further complexity and dynamism to oncologic therapy it is an important step towards individualized care.