Kimura Jiro, Sui Kenta, Tabuchi Motoyasu, Murokawa Takahiro, Sakamoto Shinya, Iwata Jun, Matsumoto Manabu, Okabayashi Takehiro
Department of Gastroenterological Surgery at Kochi Health Sciences Center, 2125-1 Ike, Kochi-City, Kochi, 781-8555, Japan.
Department of Diagnostic Pathology at Kochi Health Sciences Center, 2125-1 Ike, Kochi-City, Kochi, 781-8555, Japan.
Surg Case Rep. 2022 May 19;8(1):98. doi: 10.1186/s40792-022-01453-2.
The usefulness of neoadjuvant chemotherapy for patients with duodenal adenocarcinoma remains unclear. We report the case of a successfully resected duodenal adenocarcinoma managed by neoadjuvant chemotherapy using gemcitabine and S-1.
A 72-year-old female presented with a one-week history of abdominal bloating and vomiting after meals. Esophagogastroduodenoscopy revealed a circumferential epithelial lesion in the second portion of the duodenum. Abdominal computed tomography scan revealed thickened walls and narrowing of the duodenum. Further, an adenocarcinoma was noted on biopsy. Though she was diagnosed with duodenal adenocarcinoma, pancreatic cancer could not be completely ruled out. Therefore, she underwent neoadjuvant chemotherapy using gemcitabine and S-1 after bypass surgery. After six chemotherapy cycles, the tumor significantly reduced in size. Further, lymph nodes and distant metastases were not noted on abdominal computed tomography. The patient underwent pancreaticoduodenectomy. Pathological examination revealed a 0.5-mm lesion and surrounding fibrosis at the duodenum, distal from the ampulla of Vater and the pancreas. Her postoperative course was almost uneventful, and she was discharged on the 31st postoperative day. The patient was followed up and had no tumor recurrence at 24 months after surgery.
Neoadjuvant chemotherapy with gemcitabine and S-1 was useful in reducing the size of a duodenal adenocarcinoma. This finding would aid physicians in managing patients that present with a similar presentation.
新辅助化疗对十二指肠腺癌患者的有效性尚不清楚。我们报告了一例使用吉西他滨和S-1进行新辅助化疗后成功切除十二指肠腺癌的病例。
一名72岁女性，餐后腹胀和呕吐1周。食管胃十二指肠镜检查发现十二指肠第二部有环形上皮病变。腹部计算机断层扫描显示十二指肠壁增厚和狭窄。此外，活检发现腺癌。尽管她被诊断为十二指肠腺癌，但不能完全排除胰腺癌。因此，她在旁路手术后接受了使用吉西他滨和S-1的新辅助化疗。经过六个化疗周期后，肿瘤大小显著缩小。此外，腹部计算机断层扫描未发现淋巴结和远处转移。患者接受了胰十二指肠切除术。病理检查显示十二指肠距 Vater壶腹和胰腺远端有一个0.5毫米的病变及周围纤维化。她的术后过程基本顺利，术后第31天出院。患者接受随访，术后24个月无肿瘤复发。
吉西他滨和S-1的新辅助化疗有助于缩小十二指肠腺癌的大小。这一发现将有助于医生治疗表现类似的患者。
