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A 40-year-old man suffered from short bowel syndrome. Since a large amount of intestinal output and watery diarrhea hampered his quality of life, we tried to control the intestinal output by reducing the secretion of gastric acid with lansoprazole. Because the small intestine was only 10 cm in length and effective absorption of oral lansoprazole was doubtful, we monitored his intragastric pH for 24 hours and confirmed that the holding time above pH 3.0 was 14.5 hours (60.4%). He spent his home life eating porridge during the day, and receiving total parenteral nutrition of 1,100 mL/day at night while taking lansoprazole as an oral tablet (30 mg) once a day.

Although rare, there is a group of patients in whom lung metastases of pancreatic cancer develop isolatedly. We here report two cases of isolated lung metastasis of pancreatic cancer who gained long survival by repeated surgical resections of the nodules. Case 1: A 63-year-old man developed a 5-mm isolated lung metastasis 25 months after distal pancreatectomy for the primary cancer. He underwent an excisional biopsy for diagnosis and treatment. Although new lesions developed after this excision, additional extirpation of the chemotherapy-resistant tumor nodule realized a tumor-free survival for 15 months and total 74 months survival since pancreatectomy. Case 2: A 75-year-old man developed a 10-mm isolated lung metastasis of pancreatic cancer 13 months after distal pancreatectomy and underwent an excisional biopsy. In spite of adjuvant chemotherapy, 18 months later, a new lesion developed in the lung field neighboring the site of the first metastasis. He received a redo resection and has had a tumor-free period for 20 months until now. He has survived for 55 months since distal pancreatectomy. Aggressive excisional biopsy and repeated surgical resection could be recommended as a treatment option for isolated lung metastasis of pancreatic cancer.