Katsura Yoshiteru, Takeda Yutaka, Ohmura Yoshiaki, Sakamoto Takuya, Kawai Kenji, Inatome Junichi, Murakami Kohei, Naito Atsushi, Kagawa Yoshinori, Masuzawa Toru, Takeno Atsushi, Egawa Chiyomi, Murata Kohei
Dept. of Surgery, Kansai Rosai Hospital.
Gan To Kagaku Ryoho. 2019 Apr;46(4):802-804.
Pancreatic ductal carcinoma is one of the leading causes of cancer deaths in Japan. However, with remarkable progress in chemotherapy, studies have reported successful resection of initially unresectable pancreatic adenocarcinoma after chemotherapy. We report a case of curative surgery of pancreatic ductal adenocarcinoma with liver metastasis after chemotherapy. A 66-year-old man presenting with jaundice and weight loss was admitted to our hospital for an evaluation of pancreatic lesions. Computed tomography revealed a hypoattenuating mass in the head of the pancreas. We diagnosed this cancer as cT4(SMA>1/2)N1M0, cStage Ⅲand performed chemoradiotherapy for this locally advanced pancreatic cancer. Because of the appearance of liver metastasis, we treated this patient with GEM plus nab-PTX chemotherapy. There were no serious adverse events. After 3 therapy courses, the existing liver metastasis disappeared, and no new metastases were noted. Therefore, radical subtotal stomach-preserving pancreatoduodenectomy was performed. The tumor was diagnosed as moderately differentiated adenocarcinoma, ypT1a ypN0 ypM0, ypStage ⅠA, R0.
在日本，胰腺导管癌是导致癌症死亡的主要原因之一。然而，随着化疗取得显著进展，有研究报告称，化疗后成功切除了最初无法切除的胰腺腺癌。我们报告一例化疗后出现肝转移的胰腺导管腺癌根治性手术病例。一名66岁男性，因黄疸和体重减轻入院，接受胰腺病变评估。计算机断层扫描显示胰头有一个低密度肿块。我们将此癌症诊断为cT4（SMA>1/2）N1M0，cⅢ期，并对该局部晚期胰腺癌进行了放化疗。由于出现肝转移，我们用吉西他滨加纳米白蛋白结合型紫杉醇对该患者进行化疗。未发生严重不良事件。3个疗程治疗后，现有的肝转移消失，未发现新的转移灶。因此，实施了保留胃的根治性胰十二指肠次全切除术。肿瘤被诊断为中分化腺癌，ypT1a ypN0 ypM0，ypⅠA期，R0。
