Higashiguchi Masaya, Yamada Daisaku, Akita Hirofumi, Eguchi Hidetoshi, Iwagami Yoshifumi, Asaoka Tadafumi, Noda Takehiro, Gotoh Kunihito, Kobayashi Shogo, Sakai Daisuke, Hatano Etsuro, Ioka Tatsuya, Doki Yuichiro, Mori Masaki
Dept. of Gastroenterological Surgery, Graduate School of Medicine, Osaka University.
Gan To Kagaku Ryoho. 2019 Feb;46(2):342-344.
A 79-year-old man was referred to our hospital for treatment of hilar cholangiocarcinoma with pathological evidence. FDG-PET/CT and EUS-FNA revealed regional lymph node metastasis and no distant metastasis before the treatment. He received 6 courses of neoadjuvant gemcitabine/cisplatin/S-1 combination chemotherapy, and the imaging studies revealed partial response. However, due to impairment of the liver after chemotherapy, it was difficult to perform subsequent major hepatectomy, and we decided to continue the chemotherapy. The impairment of the liver did not recover following 11 courses of chemotherapy; on the other hand, FDG uptake was diminished on FDG-PET, and cancer cells were not detected by repeated cytology and biopsy. Extrahepatic bile duct resection with dissection of regional lymph nodes was performed, and histopathological examinationof the resected specimensuggested R0 resection.
一名79岁男性因有病理证据的肝门部胆管癌被转诊至我院。治疗前，FDG-PET/CT和EUS-FNA显示区域淋巴结转移且无远处转移。他接受了6个疗程的吉西他滨/顺铂/S-1新辅助联合化疗，影像学检查显示部分缓解。然而，由于化疗后肝脏受损，难以进行后续的大肝切除术，于是我们决定继续化疗。化疗11个疗程后肝脏损伤仍未恢复；另一方面，FDG-PET上的FDG摄取减少，多次细胞学检查和活检均未检测到癌细胞。遂行肝外胆管切除并清扫区域淋巴结，切除标本的组织病理学检查提示R0切除。
