Three Years After a Whipple Pancreaticoduodenectomy: Case Report and Review of Clinical Evolution

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, which was 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 functional status (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 and nutritional complications, ensuring improved survival and quality of life.