吉西他滨联合顺铂降期化疗成功根治性手术切除初始不可切除的肝内胆管癌：一例报告

Successful radical surgical resection of initially unresectable intrahepatic cholangiocarcinoma by downsizing chemotherapy with gemcitabine plus cisplatin: a case report.

作者信息

Takayanagi Ryosuke, Takano Shigetsugu, Sugiura Kensuke, Yoshitomi Hideyuki, Furukawa Katsunori, Takayashiki Tsukasa, Kuboki Satoshi, Kato Atsushi, Miyazaki Masaru, Ohtsuka Masayuki

机构信息

Department of General Surgery, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Cyuou-ku, Chiba, 260-8677, Japan.

Department of Gastroenterological Surgery, Mita Hospital, International University of Health and Welfare, Tokyo, Japan.

出版信息

Surg Case Rep. 2017 Nov 21;3(1):116. doi: 10.1186/s40792-017-0395-y.

DOI:10.1186/s40792-017-0395-y

PMID:29164423

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5698235/

Abstract

BACKGROUND

Intrahepatic cholangiocarcinoma (ICC) is a subtype of biliary tract cancer (BTC). Recently, downsizing chemotherapy has been applied to initially unresectable BTCs, including ICC.

CASE PRESENTATION

We report a case of liver resection in a 23-year-old woman who was diagnosed with initially unresectable ICC attached to the inferior vena cava, with portal vein (PV) cavernous transformation. Positron emission tomography (PET) showed fluorodeoxyglucose (FDG) uptake in the para-aortic lymph nodes. Upon using downsizing chemotherapy (the combination of gemcitabine [GEM] and cisplatin [CDDP]), the size of tumor reduced by 55% and FDG uptake in the para-aortic lymph node metastases disappeared. A right hemihepatectomy was performed, along with dissection of lymph nodes, including the para-aortic lymph nodes. The PV cavernous transformation was preserved to maintain collateral flow as much as possible, as it was considered to originate from a congenital anomaly. Pathological examination revealed that R0 resection was performed and that there were no viable neoplastic cells remaining in the para-aortic lymph nodes. The patient is alive at 31 months after initial treatment, with a local recurrence.

CONCLUSION

Downsizing chemotherapy with GEM plus CDDP followed by radical surgical resection is an attractive treatment for initially unresectable BTC.

摘要

背景

肝内胆管癌（ICC）是胆道癌（BTC）的一种亚型。最近，降期化疗已应用于包括ICC在内的初始不可切除的BTC。

病例报告

我们报告一例23岁女性肝切除术病例，该患者被诊断为初始不可切除的ICC，肿瘤附着于下腔静脉，伴有门静脉（PV）海绵样变性。正电子发射断层扫描（PET）显示腹主动脉旁淋巴结有氟脱氧葡萄糖（FDG）摄取。使用降期化疗（吉西他滨[GEM]和顺铂[CDDP]联合）后，肿瘤大小缩小了55%，腹主动脉旁淋巴结转移灶的FDG摄取消失。进行了右半肝切除术，并清扫了包括腹主动脉旁淋巴结在内的淋巴结。由于PV海绵样变性被认为源于先天性异常，故予以保留以尽可能维持侧支血流。病理检查显示实现了R0切除，腹主动脉旁淋巴结无存活肿瘤细胞残留。患者初始治疗后31个月存活，但出现了局部复发。