Yura Masahiro, Takano Kiminori, Adachi Kiyohiko, Hara Asuka, Hayashi Keita, Tajima Yuki, Kaneko Yasushi, Ikoma Yoichiro, Fujisaki Hiroto, Hirata Akira, Hongo Kumiko, Yo Kikuo, Yoneyama Kimiyasu, Dehari Reiko, Koyanagi Kazuo, Nakagawa Motohito
Department of Surgery, Hiratsuka City Hospital, Hiratsuka 2540065, Kanagawa, Japan.
Department of Surgical Pathology, Hiratsuka City Hospital, Hiratsuka 2540065, Kanagawa, Japan.
World J Gastroenterol. 2021 Feb 14;27(6):534-544. doi: 10.3748/wjg.v27.i6.534.
Pancreaticoduodenectomy (PD) for advanced gastric cancer is rarely performed because of the high morbidity and mortality rates and low survival rate. However, neoadjuvant chemotherapy for advanced gastric cancer has improved, and chemotherapy combined with trastuzumab may have a preoperative tumor-reducing effect, especially for human epidermal growth factor receptor 2 (HER2)-positive cases.
We report a case of successful radical resection with PD after neoadjuvant S-1 plus oxaliplatin (SOX) and trastuzumab in a patient (66-year-old male) with advanced gastric cancer invading the pancreatic head. Initial esophagogastroduodenoscopy detected a type 3 advanced lesion located on the lower part of the stomach obstructing the pyloric ring. Computed tomography detected lymph node metastasis and tumor invasion to the pancreatic head without distant metastasis. Pathological findings revealed adenocarcinoma and HER2 positivity (immunohistochemical score of 3 +). We performed staging laparoscopy and confirmed no liver metastasis, no dissemination, negative lavage cytological findings, and immobility of the distal side of the stomach due to invasion to the pancreas. Laparoscopic gastrojejunostomy was performed at that time. One course of SOX and three courses of SOX plus trastuzumab were administered. Preoperative computed tomography showed partial response; therefore, PD was performed after neoadjuvant chemotherapy, and pathological radical resection was achieved.
We suggest that radical resection with PD after neoadjuvant chemotherapy plus trastuzumab is an option for locally advanced HER2-positive gastric cancer invading the pancreatic head in the absence of non-curative factors.
由于高发病率、高死亡率和低生存率，晚期胃癌很少行胰十二指肠切除术（PD）。然而，晚期胃癌的新辅助化疗有所改善，化疗联合曲妥珠单抗可能具有术前肿瘤缩小作用，尤其是对于人表皮生长因子受体2（HER2）阳性病例。
我们报告1例66岁男性晚期胃癌侵犯胰头患者，经新辅助S-1联合奥沙利铂（SOX）及曲妥珠单抗治疗后成功行根治性PD切除。初次食管胃十二指肠镜检查发现胃下部3型进展期病变，阻塞幽门环。计算机断层扫描发现有淋巴结转移及肿瘤侵犯胰头，无远处转移。病理检查结果显示为腺癌且HER2阳性（免疫组化评分为3+）。我们进行了分期腹腔镜检查，确认无肝转移、无播散、灌洗细胞学检查结果阴性，且因肿瘤侵犯胰腺导致胃远端固定不动。当时进行了腹腔镜胃空肠吻合术。给予1个疗程的SOX及3个疗程的SOX联合曲妥珠单抗治疗。术前计算机断层扫描显示部分缓解；因此，在新辅助化疗后行PD，实现了病理根治性切除。
我们认为，对于局部晚期HER2阳性胃癌侵犯胰头且不存在不可治愈因素的患者，新辅助化疗联合曲妥珠单抗后行根治性PD切除是一种选择。
