Pancreatic Cancer after Living-Donor Liver Transplantation: A Case Report of Long-Term Recurrence-Free Survival after Pancreaticoduodenectomy Followed by Adjuvant Chemotherapy.

Abstract

Introduction: Malignancies are a major cause of late mortality after liver transplantation (LT), with an incidence significantly higher than that in the general population. Pancreatic cancer (PC) occurring after LT carries a dismal prognosis; however, the feasibility and outcome of surgery and perioperative chemotherapy remain unclear.

Case presentation: A 73-year-old Japanese woman who had undergone living-donor LT 16 years earlier for hepatitis C virus-related cirrhosis was diagnosed with PC during routine CT surveillance in outpatient follow-up. A 23-mm hypovascular tumor in the pancreatic head was found to abut the portal vein (PV), without nodal or distant metastasis. After initiation of neoadjuvant gemcitabine plus S-1, treatment was discontinued during the first cycle because of S-1-induced enteritis requiring hospitalization and intravenous hydration. After recovery of her general condition, she underwent subtotal stomach-preserving pancreaticoduodenectomy with PV resection and reconstruction. During the operation, the pre-existing hepaticojejunostomy was preserved, and pancreaticojejunostomy was created using the blind end of the preserved afferent Roux limb. She was discharged on POD 25 without major complications. Pathological examination revealed well-differentiated pancreatic ductal adenocarcinoma, ypT2N0M0, Stage IB (UICC 9th edition). She subsequently completed 6 months of adjuvant gemcitabine without severe adverse events. No recurrence has been detected during 3 years of postoperative follow-up.

Conclusions: Early detection and curative-intent surgery followed by adjuvant chemotherapy may contribute to long-term recurrence-free survival in selected LT recipients with localized PC. Careful multidisciplinary management may support safe oncologic treatment in these medically complex patients.