Ariake Kyohei, Motoi Fuyuhiko, Mizuma Masamichi, Murakami Keigo, Takadate Tatsuyuki, Ohtsuka Hideo, Fukase Koji, Masuda Kunihiro, Hayashi Hiroki, Nakagawa Kei, Sakata Naoaki, Morikawa Takanori, Maeda Shimpei, Naitoh Takeshi, Egawa Shinichi, Unno Michiaki
Department of Surgery, Tohoku University Graduate School of Medicine, Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan.
Department of Pathology, Tohoku University, 1-1, Seiryocho, Aobaku, Sendai, Japan.
Surg Case Rep. 2017 Dec;3(1):15. doi: 10.1186/s40792-017-0290-6. Epub 2017 Jan 18.
The prognosis for pancreatic cancer remains dismal because many patients are diagnosed with unresectable cancer at the initial diagnosis. Recently, conversion surgery was reported as an effective treatment for initially unresectable pancreatic cancer with a favorable response to non-surgical treatment lasting over 240 days. Here, we describe a case of locally advanced pancreatic cancer (LAPC) successfully resected after treatment with S-1 and radiation followed by gemcitabine/nab-paclitaxel therapy.
A 73-year-old man with LAPC was referred to our hospital. Computed tomography findings revealed a 2.5-cm mass in the pancreatic body that had invaded the celiac artery, common hepatic artery, and splenic artery. Superior mesenteric artery (SMA) encasement was not observed, but tumor abutment over 180° with the main tumor was detected. Staging laparoscopy showed no findings of distant metastasis, and washing cytology revealed no malignancy. He was diagnosed with unresectable pancreatic cancer. Treatment with S-1 with radiation therapy followed by gemcitabine with nab-paclitaxel was performed. Six months after the initial treatment, the tumor size had decreased to 1.2 cm, and encasement of the main artery was diminished. Though abutment to the main artery, including the SMA, was still detected, distal pancreatectomy with celiac artery resection was performed. The histopathological findings around the celiac artery revealed fibrous changes with an Evans classification of grade IIb. There was no residual cancer at the periphery; thus, R0 resection was achieved. The patient has been healthy and without recurrence for more than 12 months since the initial treatment.
Gemcitabine/nab-paclitaxel therapy revealed high response rate for metastasic pancreatic cancer (PC), but the effect for LAPC proposing conversion surgery was not well discussed. In this case, we achieve R0 resection combined with chemoradiation therapy and gemcitabine/nab-paclitaxel therapy. This regimen was also effective for LAPC and may be used to increase the population of conversion surgery by its high response rate.
胰腺癌的预后仍然很差，因为许多患者在初次诊断时就被诊断为无法切除的癌症。最近，转化手术被报道为一种有效的治疗方法，用于治疗最初无法切除的胰腺癌，对持续超过240天的非手术治疗有良好反应。在此，我们描述一例局部晚期胰腺癌（LAPC）患者，在接受S-1和放疗，随后接受吉西他滨/纳米白蛋白结合型紫杉醇治疗后成功切除。
一名患有LAPC的73岁男性被转诊至我院。计算机断层扫描结果显示胰体有一个2.5厘米的肿块，已侵犯腹腔干、肝总动脉和脾动脉。未观察到肠系膜上动脉（SMA）包绕，但检测到与主肿瘤超过180°的肿瘤邻接。分期腹腔镜检查未发现远处转移，冲洗细胞学检查未发现恶性肿瘤。他被诊断为无法切除的胰腺癌。进行了S-1联合放射治疗，随后是吉西他滨联合纳米白蛋白结合型紫杉醇治疗。初始治疗6个月后，肿瘤大小降至1.2厘米，主要动脉的包绕减轻。尽管仍检测到包括SMA在内的主要动脉邻接，但进行了腹腔干切除的远端胰腺切除术。腹腔干周围的组织病理学检查结果显示为纤维性改变，Evans分类为IIb级。周边无残留癌；因此，实现了R0切除。自初始治疗以来，患者已健康超过12个月且无复发。
吉西他滨/纳米白蛋白结合型紫杉醇治疗对转移性胰腺癌（PC）显示出高反应率，但对于提议进行转化手术的LAPC的效果尚未得到充分讨论。在本病例中，我们通过放化疗和吉西他滨/纳米白蛋白结合型紫杉醇治疗实现了R0切除。该方案对LAPC也有效，可能因其高反应率而用于增加转化手术的患者群体。
