Sumiyoshi Hiroki, Matsushita Akira, Nakamura Yoshiharu, Yamahatsu Kazuya, Katsuno Akira, Uchida Eiji
Dept. of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School.
Gan To Kagaku Ryoho. 2014 May;41(5):669-72.
We report a case of locally advanced pancreatic tail adenosquamous carcinoma that was treated by performing R0 resection after neoadjuvant chemotherapy with S-1 and gemcitabine. A 75-year-old man visited our hospital because of left lateral abdominal pain. On the basis of computed tomography and endoscopic biopsy findings, an 80-mm locally advanced pancreatic tail carcinoma with direct invasion to the gastric upper body, splenic flexure of the colon, and left kidney was diagnosed. Combined chemotherapy with S-1 and gemcitabine was initiated for reduction in the tumor size. After 11 courses of treatment, computed tomography revealed a partial response in tumor size reduction. Grade 3 neutropenia was observed as an adverse event. Distal pancreatectomy, proximal gastrectomy, partial resection of the descending colon, resection of the left kidney and left adrenal gland, and D2 lymph node dissection were performed. The pathological diagnosis was adenosquamous carcinoma in the pancreatic tail, and an R0 resection was achieved. However, a month after surgery, multiple distant liver metastases were observed. Neoadjuvant chemotherapy with S-1 and gemcitabine may reduce the tumor size in locally advanced pancreatic tail adenosquamous carcinoma and increase the R0 resection rate. However, treatment for distant metastasis is warranted in cases of pancreatic adenosquamous carcinoma.
我们报告一例局部晚期胰尾腺鳞癌病例，该病例在接受S-1和吉西他滨新辅助化疗后进行了R0切除。一名75岁男性因左侧腹痛前来我院就诊。根据计算机断层扫描和内镜活检结果，诊断为直径80mm的局部晚期胰尾癌，肿瘤直接侵犯胃体上部、结肠脾曲和左肾。开始采用S-1和吉西他滨联合化疗以缩小肿瘤大小。经过11个疗程的治疗，计算机断层扫描显示肿瘤大小有部分缓解。观察到3级中性粒细胞减少作为不良事件。进行了胰体尾切除术、近端胃切除术、降结肠部分切除术、左肾和左肾上腺切除术以及D2淋巴结清扫术。病理诊断为胰尾腺鳞癌，实现了R0切除。然而，术后一个月，观察到多发远处肝转移。S-1和吉西他滨新辅助化疗可能会缩小局部晚期胰尾腺鳞癌的肿瘤大小并提高R0切除率。然而，对于腺鳞癌病例，有必要进行远处转移的治疗。
