Department of Gastroenterological Surgery, Kochi Health Sciences Center, Kochi-City, Japan.
Department of Radiology, Kochi Health Science Center, Kochi-City, Japan.
Surg Technol Int. 2024 Jul 15;44:139-142. doi: 10.52198/24.STI.44.GS1768.
Ampulla of Vater carcinoma (AVC) with para-aortic node (PAN) metastasis is considered unresectable and is equivalent to distant metastasis, contributing to poor outcomes.
A 60-year-old man was referred to our hospital and was diagnosed with an unresectable ampulla of Vater carcinoma that had metastasized to the para-aortic nodes. The patient received a systemic chemotherapy regimen comprising a combination of gemcitabine and cisplatin. Following five cycles of treatment, imaging studies revealed a significant reduction in the primary tumor and para-aortic node metastasis, rendering detection difficult. Pancreatoduodenectomy with para-aortic node dissection was performed as a radical surgery. Upon pathological examination, no residual tumors were identified in the resected specimen, indicating that the systemic chemotherapy achieved a complete pathological response. The postoperative course of the patient was uneventful, and he was discharged on the 25th postoperative day. The patient was followed up as an outpatient and remained stable without any recurrence for two months after surgery.
Neoadjuvant chemotherapy with gemcitabine and cisplatin was useful for downstaging the ampulla in patients with Vater carcinoma. This finding may help physicians manage patients with similar presentations.
Vater 壶腹癌伴主动脉旁淋巴结（PAN）转移被认为是不可切除的，相当于远处转移，导致预后不良。
一名 60 岁男性被转至我院，诊断为不可切除的 Vater 壶腹癌，已转移至主动脉旁淋巴结。患者接受了吉西他滨和顺铂联合的全身化疗方案。经过五个周期的治疗，影像学研究显示原发肿瘤和主动脉旁淋巴结转移明显缩小，难以检测。对患者进行了胰十二指肠切除术和主动脉旁淋巴结清扫术作为根治性手术。病理检查发现切除标本中无残留肿瘤，表明全身化疗达到了完全病理缓解。患者术后恢复顺利，第 25 天出院。患者作为门诊病人接受随访，术后两个月稳定，无复发。
吉西他滨和顺铂的新辅助化疗对 Vater 壶腹癌患者的壶腹降期有效。这一发现可能有助于医生治疗具有类似表现的患者。
