Hatsuzawa Yuuri, Mizuma Masamichi, Motoi Fuyuhiko, Hata Tatsuo, Iseki Masahiro, Takadate Tatsuyuki, Ohtsuka Hideo, Sakata Naoaki, Morikawa Takanori, Nakagawa Kei, Hayashi Hiroki, Naitoh Takeshi, Kanno Atsushi, Shimosegawa Tooru, Unno Michiaki
Dept. of Surgery, Tohoku University Graduate School of Medicine.
Gan To Kagaku Ryoho. 2018 Feb;45(2):347-349.
Here we report a case of pancreatic cancer(PC)with peritoneal dissemination, underwent conversion surgery following chemotherapy for 2 years. A5 5-year-old woman was referred to our hospital for treatment of PC. Abdominal CT scan revealed 3.0 cm of a pancreatic head tumor with abutment of the portal vein and the hepatic artery, classified as borderline resectable. Staging laparoscopy(SL)showed positive peritoneal cytology(CY). Gemcitabine(Gem)plus S-1 therapy(GS) was performed. Ten months after initial GS, SL revealed the disseminated nodule and positive CY. The regimen was changed to Gem plus nab-paclitaxel therapy(Gem plus nab-PTX). Since right ovarian tumor was detected by CT scan 6 months after initial Gem plus nab-PTX, laparoscopic oophorectomy was performed. Histological findings showed positive CY and ovarian metastasis of PC. Afterward, Gem plus nab-PTX has been continued for 8 months. Since SL after 2 years from initial chemotherapy showed negative CY and no metastatic lesion, pancreaticoduodenectomy with portal vein resection was performed as conversion surgery. According to General Rules for the Study of Pancreatic Cancer the 7th edition by Japan Pancreas Society, histological findings showed ypT3, ypN0, R0, and Grade 1b of histological effect. The patient is alive without recurrence 6 months after the resection.
我们在此报告一例伴有腹膜播散的胰腺癌（PC）患者，在接受了2年化疗后接受了转化手术。一名55岁女性因PC被转诊至我院治疗。腹部CT扫描显示胰头肿瘤3.0 cm，与门静脉和肝动脉相邻，分类为可切除边界。分期腹腔镜检查（SL）显示腹腔细胞学（CY）阳性。进行了吉西他滨（Gem）加S-1治疗（GS）。初始GS治疗10个月后，SL显示有播散结节且CY阳性。治疗方案改为Gem加纳米白蛋白结合型紫杉醇治疗（Gem加纳米白蛋白结合型紫杉醇）。初始Gem加纳米白蛋白结合型紫杉醇治疗6个月后，CT扫描发现右侧卵巢肿瘤，遂行腹腔镜卵巢切除术。组织学检查结果显示CY阳性及PC卵巢转移。此后，Gem加纳米白蛋白结合型紫杉醇持续治疗8个月。由于初始化疗2年后的SL显示CY阴性且无转移灶，遂行胰十二指肠切除术加门静脉切除术作为转化手术。根据日本胰腺学会第7版《胰腺癌研究总则》，组织学检查结果显示ypT3、ypN0、R0，组织学疗效为1b级。患者术后6个月存活且无复发。
