Three Years After a Whipple Pancreaticoduodenectomy: Case Report and Review of Clinical Evolution
Year: 2025
Type: article
Abstract: Three years after a Whipple pancreaticoduodenectomy, a 62-year-old male patient presented with progressive obstructive jaundice, pruritus, dark urine, and weight loss. Imaging revealed a 4-cm mass in the second portion of the duodenum causing obstruction of the bile and pancreatic ducts. Biopsy confirmed moderately differentiated duodenal adenocarcinoma. The patient underwent classical Whipple pancreaticoduodenectomy with R0 resection. The postoperative course was notable for delayed gastric emptying, whichwas managed conservatively. Histopathology confirmed pT3N1M0 disease, and adjuvant fluoropyrimidine-based chemotherapy was administered for six months. During 36 months of follow-up, the patient remained free of tumor recurrence, with preserved functionalstatus (ECOG 1), manageable exocrine pancreatic insufficiency, and controlled pancreatogenic diabetes. Duodenal adenocarcinoma is a rare malignancy that often presents with nonspecific symptoms until periampullary obstruction occurs. Complete resection with negative margins is the key prognostic factor. This case demonstrates that careful patient selection, surgery performed in specialized centers, and adjuvant therapy can lead to favorable long-term oncologic and functional outcomes. The Whipple procedure, although technically demanding and associated with both early and late complications, remains the standard curative-intent treatment for resectable duodenal adenocarcinoma. Long-term surveillance is essential to detect recurrence and manage metabolic andnutritional complications, ensuring improved survival and quality of life.
Authors: Jose Angel Rodriguez Diaz, Jaime Yahel Rangel Reyes, Andrea Karla Pichardo Cervantes, Jairline Temahuay Montiel, David Gómez Catzoli, Paola Mariel Olivas González, Roberto Páez Sánchez, Kevin Suarez Arias Campus, Aldana Cerda Lizbeth Guadalupe, Arturo Crespo, Joab Josué Rangel Reyes
Institutions: Mexican Social Security Institute, Servicios de Salud del Instituto Mexicano del Seguro Social para el Bienestar, Universidad Autónoma de Guadalajara, Universidad Michoacana de San Nicolás de Hidalgo, Universidad Autónoma de Sinaloa, Centro Universitario Siglo XXI, Universidad Autónoma Metropolitana
Language: English
Subfield: Oncology
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
OpenAlex ID: W7090168267
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