Shimura Mitsuhiro, Mizuma Masamichi, Hayashi Hiroki, Mori Akiko, Tachibana Tomoyoshi, Hata Tatsuo, Iseki Masahiro, Takadate Tatsuyuki, Ariake Kyohei, Maeda Shimpei, Ohtsuka Hideo, Sakata Naoaki, Morikawa Takanori, Nakagawa Kei, Naitoh Takeshi, Kamei Takashi, Motoi Fuyuhiko, Unno Michiaki
Department of Surgery, Graduate School of Medicine, Tohoku University, 1-1 Seiryomachi, Aobaku, Sendai, 980-8574, Japan.
Surg Case Rep. 2017 Dec 29;3(1):132. doi: 10.1186/s40792-017-0409-9.
Pancreatic cancer with distant metastases is classified as "unresectable," for which the standard treatment is systemic chemotherapy. The effectiveness of radical resection for pancreatic cancer with distant metastases is unknown. Here, we report a case of long term survival treated with conversion surgery following chemotherapy after diagnostic metastasectomy for pancreatic cancer with synchronous liver metastasis.
A 73-year-old man was referred to our hospital to examine and treat for cancer of the pancreatic body. Computed tomography (CT) scan revealed a 26-mm hypovascular tumor in contact with the common hepatic artery (CHA) (> 180°), the celiac artery (< 180°), and portal vein at the pancreatic body. Resectability was determined as "borderline resectable." Two courses of gemcitabine plus S-1 combination therapy (GS) were administered as neoadjuvant chemotherapy (NAC). CT scan showed tumor shrinkage (21 mm), determined as stable disease (SD) according to Response Evaluation Criteria in Solid Tumors (RECIST). Although the abdomen was opened for radical resection, a small nodule on the liver was detected and removed. Since the nodule was diagnosed as adenocarcinoma by intraoperative frozen section, resection of the primary tumor was not performed. After three subsequent courses of GS therapy, no distant metastases were detected under radiological findings. Distal pancreatectomy with celiac artery resection (DP-CAR) was performed as radical surgery 6 months after the initial diagnosis. Histological diagnosis was well-differentiated tubular adenocarcinoma, showing ypT1 ypN1 M1 stage IV, negative surgical margin (R0), and grade III in the Evans classification. S-1 was administered every other day from 6 months after resection up to the present. The patient has been alive with no recurrence for 5 years after the initial diagnosis and 4.5 years after the resection.
There is a case that received survival benefits from conversion surgery following chemotherapy after diagnostic metastasectomy in pancreatic cancer with synchronous liver metastasis.
伴有远处转移的胰腺癌被归类为“不可切除”，其标准治疗方法是全身化疗。胰腺癌伴远处转移行根治性切除的有效性尚不清楚。在此，我们报告一例同步肝转移的胰腺癌患者，在诊断性转移灶切除术后接受化疗，随后行转化手术并获得长期生存的病例。
一名73岁男性因胰体癌被转诊至我院检查和治疗。计算机断层扫描（CT）显示胰体部有一个26毫米的低血运肿瘤，与肝总动脉（CHA）（>180°）、腹腔干动脉（<180°）和门静脉相邻。可切除性被判定为“边界可切除”。给予两疗程吉西他滨联合S-1（GS）方案作为新辅助化疗（NAC）。CT扫描显示肿瘤缩小（21毫米），根据实体瘤疗效评价标准（RECIST）判定为疾病稳定（SD）。尽管已打开腹腔进行根治性切除，但在肝脏上发现并切除了一个小结节。由于术中冰冻切片诊断该结节为腺癌，因此未进行原发肿瘤切除。在随后三个疗程的GS治疗后，影像学检查未发现远处转移。在初次诊断6个月后，行根治性手术，即远端胰腺切除术联合腹腔干动脉切除（DP-CAR）。组织学诊断为高分化管状腺癌，Evans分类为ypT1 ypN1 M1 Ⅳ期，手术切缘阴性（R0），Ⅲ级。自切除术后6个月起至今，每隔一天给予S-1治疗。患者在初次诊断后5年、切除术后4.5年仍存活且无复发。
有一例同步肝转移的胰腺癌患者，在诊断性转移灶切除术后接受化疗，随后行转化手术并从中获益。
