化疗后病理完全缓解的初诊不可切除的壶腹癌的转化手术：病例报告

Sato Yo, Hara Takanobu, Takami Yuko, Wada Yoshiyuki, Ryu Tomoki, Sasaki Shin, Yoshitomi Munehiro, Momosaki Seiya, Murakami Masatoshi, Hijioka Masayuki, Kaku Toyoma, Kawabe Ken, Saitsu Hideki

Department of Hepato-Biliary-Pancreatic Surgery, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, 1-8-1 Jigyohama Chuo-ku, Fukuoka, 810-8563, Japan.

Department of Pathology, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan.

Surg Case Rep. 2019 Jul 30;5(1):122. doi: 10.1186/s40792-019-0680-z.

BACKGROUND

Carcinoma of the ampulla of Vater with distant metastases is regarded as unresectable. Systemic chemotherapy is basically the treatment of choice for such tumors.

CASE PRESENTATION

A 68-year-old woman was referred to our hospital and diagnosed with carcinoma of the ampulla of Vater with lymph node and multiple liver metastases. She underwent systemic chemotherapy with a combination of gemcitabine and cisplatin. After 19 months of treatment, the primary tumor and liver metastases were difficult to detect on follow-up images. Shrinkage of the enlarged lymph nodes was also confirmed. Surgical resection was performed with curative intent after a multidisciplinary meeting. Pathological examination of the resected specimen showed no residual tumors. Systemic chemotherapy achieved a pathological complete response. The postoperative course was uneventful, and the patient remained free of recurrent disease at 10 months of follow-up.

CONCLUSION

This case shows the possibility of conversion surgery after systemic chemotherapy for carcinoma of the ampulla of Vater.

背景

伴有远处转移的壶腹癌被视为不可切除。全身化疗基本上是这类肿瘤的首选治疗方法。

病例介绍

一名68岁女性被转诊至我院，诊断为壶腹癌伴淋巴结及多发肝转移。她接受了吉西他滨和顺铂联合的全身化疗。治疗19个月后，随访影像难以检测到原发肿瘤和肝转移灶。肿大淋巴结的缩小也得到证实。多学科会诊后进行了根治性手术切除。切除标本的病理检查显示无残留肿瘤。全身化疗实现了病理完全缓解。术后过程顺利，随访10个月时患者无疾病复发。