Mineta Shumei, Okada Toshimasa, Sanuki Fumiaki, Iwamoto Ryo, Kitagawa Shuji, Kinoshita Seiya, Ueno Michi, Kubota Hisako, Tanaka Hironori, Higashida Masaharu, Ito Yoshitomo, Endo Shunji, Yoshimatsu Kazuhiko, Fujiwara Yoshinori, Ueno Tomio
Dept. of Digestive Surgery, Kawasaki Medical School.
Gan To Kagaku Ryoho. 2022 Dec;49(13):1814-1816.
A 57-year-old man was diagnosed with a tumor in the pancreatic body at a nearby hospital and consulted our hospital. Examinations revealed that carbohydrate antigen 19-9(CA19-9)levels were 1,765.0 U/mL. We confirmed metastatic liver tumors in S4 and S8 of the liver by EOB-MRI. We diagnosed unresectable pancreatic cancer(T3N0M1, cStage Ⅳ)and administered 10 courses of gemcitabine(GEM)plus nab-paclitaxel(nab-PTX)therapy. The main lesion and the lesion in S4 subsequently disappeared, and the lesion in S8 degenerated into a cyst. CA19-9 levels were 113 U/mL. Surgery was determined as the best course of action after normalizing CA19-9 levels. Therefore, we further administered 6 courses of FOLFIRINOX therapy and 4 courses of GEM plus nab-PTX therapy, but CA19-9 was not normalized. We decided that it would be difficult to normalize CA19-9, and thus proceeded with surgery. During the operation, cystic degenerative lesions were found in S8 and peritoneal dissemination was found in the transverse mesentery. Because the ascites cytopathology was negative, it was judged that the peritoneal dissemination was localized. We performed distal pancreatectomy(D2)plus partial hepatectomy(S8)plus peritoneal dissemination resection. On day 52 after surgery, we resumed GEM plus nab-PTX. The patient has survived without any recurrence for 3 years after the initial surgery.
一名57岁男性在附近医院被诊断出胰体部肿瘤，随后前来我院咨询。检查发现糖类抗原19-9（CA19-9）水平为1765.0 U/mL。我们通过EOB-MRI确认肝脏S4和S8存在转移性肝肿瘤。我们诊断为不可切除的胰腺癌（T3N0M1，c期Ⅳ），并给予吉西他滨（GEM）联合纳米白蛋白结合型紫杉醇（nab-PTX）治疗10个疗程。主病灶及S4病灶随后消失，S8病灶退化为囊肿。CA19-9水平为113 U/mL。在CA19-9水平恢复正常后，手术被确定为最佳治疗方案。因此，我们进一步给予6个疗程的FOLFIRINOX治疗和4个疗程的GEM联合nab-PTX治疗，但CA19-9未恢复正常。我们认为很难使CA19-9恢复正常，于是进行了手术。手术中，在S8发现囊性退变病灶，在横结肠系膜发现腹膜播散。由于腹水细胞病理学检查为阴性，判断腹膜播散为局限性。我们进行了胰体尾切除术（D2）加肝部分切除术（S8）加腹膜播散切除术。术后第52天，我们恢复了GEM联合nab-PTX治疗。患者在初次手术后已存活3年，无任何复发。
