Pancreaticoduodenectomy with combined superior mesenteric artery and vein resection for isolated lymph node recurrence of colon cancer: a case report.

INTRODUCTION

Pancreatoduodenectomy (PD) with combined superior mesenteric artery (SMA) resection is considered extremely invasive and is rarely indicated, even for pancreatic or biliary tract malignancies, as it seldom results in favorable long-term outcomes. To date, no reports have described PD with combined SMA resection performed for isolated lymph node recurrence of colorectal cancer (CRC).

CASE PRESENTATION: A 68‑year‑old man underwent laparoscopic right hemicolectomy followed by adjuvant chemotherapy for ascending colon cancer. Two years later, a solitary recurrent lymph node was detected on the ventral aspect of the gastrocolic trunk and SMA. After six cycles of FOLFOXIRI plus bevacizumab, the lesion decreased in size with no evidence of additional metastases. The patient subsequently underwent PD with combined resection of the SMA and superior mesenteric vein, with arterial reconstruction using a great saphenous vein graft. Histopathological examination confirmed an R0 resection.

DISCUSSION: Although SMA resection during PD is rarely performed because of its technical complexity and historically poor outcomes, this case illustrates that aggressive surgical management may be justified in highly selected patients with isolated CRC recurrence. The solitary nature of the lesion, favorable response to chemotherapy, and absence of other metastases supported the decision to pursue radical resection with vascular reconstruction.

CONCLUSION

This case suggests that PD with combined SMA resection may be a feasible treatment option for selected patients with isolated lymph node recurrence of CRC. Further accumulation of cases is needed to clarify optimal management strategies and long-term outcomes for this rare clinical scenario.