Nomoto K, Hishida M, Hayashi M, Nomoto S. Late nodal recurrence after two curative resections for microinvasive intraductal papillary mucinous carcinoma: A case report. World J Gastrointest Surg 2026; 18(5): 118166 [DOI: 10.4240/wjgs.v18.i5.118166]
Corresponding Author of This Article
Mitsuhiro Hishida, MD, PhD, Lecturer, Department of Surgery, Aichi-Gakuin University School of Dentistry, 2-11 Suemori-dori, Chikusa-ku, Nagoya 464-8651, Aichi, Japan. m-hishi@dpc.agu.ac.jp
Research Domain of This Article
Oncology
Article-Type of This Article
case-report
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Nomoto K, Hishida M, Hayashi M, Nomoto S. Late nodal recurrence after two curative resections for microinvasive intraductal papillary mucinous carcinoma: A case report. World J Gastrointest Surg 2026; 18(5): 118166 [DOI: 10.4240/wjgs.v18.i5.118166]
Kosuke Nomoto, Mitsuhiro Hishida, Shuji Nomoto, Department of Surgery, Aichi-Gakuin University School of Dentistry, Nagoya 464-8651, Aichi, Japan
Kosuke Nomoto, Department of Surgery, Nagoya Central Hospital, Nagoya 453-0801, Aichi, Japan
Masamichi Hayashi, Department of Gastroenterological Surgery, Nagoya University Graduate School of Medicine, Nagoya 466-8560, Aichi, Japan
Author contributions: Nomoto K wrote the manuscript; Hishida M revised the manuscript, performed the pathological evaluation, and supervised the overall preparation of the paper; Hayashi M managed the clinical case, and performed the pathological evaluation; Nomoto S performed the surgery, managed the clinical case, and contributed to the organization of the manuscript; all authors have read and approved the final manuscript.
AI contribution statement: AI tools (ChatGPT and Microsoft Copilot) were used for language polishing, translation, and writing assistance aimed at improving the clarity of expression.
Informed consent statement: Written informed consent for the surgical procedure and chemotherapy was obtained from all patients. Following the patient’s death, written consent for the publication of this case report was provided by the patient’s family in accordance with institutional policies.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Corresponding author: Mitsuhiro Hishida, MD, PhD, Lecturer, Department of Surgery, Aichi-Gakuin University School of Dentistry, 2-11 Suemori-dori, Chikusa-ku, Nagoya 464-8651, Aichi, Japan. m-hishi@dpc.agu.ac.jp
Received: December 31, 2025 Revised: January 23, 2026 Accepted: February 27, 2026 Published online: May 27, 2026 Processing time: 149 Days and 1.3 Hours
Abstract
BACKGROUND
Intraductal papillary mucinous neoplasms (IPMNs) are precursors of pancreatic ductal adenocarcinoma and often harbor KRAS and GNAS mutations. Although disease progression may take a decade or longer, very late recurrence after curative resection is rare. The treatment options for older patients remain limited due to their poor tolerance to standard chemotherapy.
CASE SUMMARY
Herein, we report the case of a 92-year-old woman with multicentric main duct microinvasive intraductal papillary mucinous carcinoma who underwent two curative resections (spleen-preserving distal pancreatectomy in 2005 and pylorus-preserving complete total pancreatectomy in 2007). Thirteen years after the second resection, at age 89, the patient developed an isolated lymph node recurrence with markedly elevated tumor marker levels (carbohydrate antigen 19-9, 1080 U/mL; duodenal pancreatic cancer antigen-2, 820 U/mL). Considering the patient’s advanced age and frailty, alternate-day low-dose S-1 (40 mg/day) therapy was initiated. The treatment was well-tolerated, and complete radiological and serological remission was achieved within 9 months. The patient remained recurrence-free until age 91 and ultimately died of pneumonia and senile decline at age 92 without evidence of cancer.
CONCLUSION
IPMN requires lifelong surveillance; late recurrence can occur, and individualized treatment is crucial in older patients.
Core Tip: Microinvasive intraductal papillary mucinous carcinoma (IPMC) is generally considered an indolent precursor of pancreatic ductal adenocarcinoma, and curative resection is expected to provide long-term disease control. This case illustrates that microinvasive IPMC can nevertheless exhibit extremely late lymph node recurrence more than a decade after two curative pancreatic resections. The findings highlight the slow but persistent malignant potential of microinvasive IPMC and emphasize the necessity of lifelong postoperative surveillance. In addition, this case underscores the importance of individualized management strategies for recurrence in very elderly patients.
