The case of a person who let to umbilicus metastasis at a year after PD

We present the case of a 70-year-old female who was admitted to our hospital due to jaundice. Abdominal computed tomography revealed stenosis of periampullary region that was led to cancer of pancreas, so PTCD tube was taken into intrahepatic bile duct before surgery, and we carried out pancreaticoduodenectomy (PD) + D2, #16 lymph node dissection. Four months after PD, abdominal computer tomography revealed 1 cm-in-diameter skin metastatic lesion that pulled out the PTCD tube 2 weeks after PD, so she underwent a tumor resection and chemo-radiation (50 Gy (2 Gy × 25 times) + GEM 1,000 mg/m2). Seventeen months after PD, a metastatic lesion in 19 mm-in-diameter appeared in umbilicus. We resected the umbilicus tumor because local recurrence at the pulled out PTCD tube took a good control. At an umbilicus resection, there was peritoneal dissemination. Therefore, we kept her to undergo GEM 1 ,000 mg/m2, but she was dead (2 years after PD). Umbilicus metastasis creates the appearance of the patient looks bad. So we thought that the umbilicus resection was meaningful even if the resection did not contribute her prognosis.