Taguchi Masanobu, Sasanuma Hideki, Shinoda Masayuki, Meguro Yoshiyuki, Morishima Kazue, Miyato Hideyo, Ohzawa Hideyuki, Endo Kazuhiro, Sano Naoki, Kawata Hirotoshi, Fukushima Noriyoshi, Sakuma Yasunaru, Yamaguchi Hironori, Kitayama Joji, Sata Naohiro
Department of Surgery, Jichi Medical University School of Medicine, Shimotsuke, Tochigi, Japan.
Department of Pathology, Jichi Medical University, Shimotsuke, Tochigi, Japan.
Surg Case Rep. 2025;11(1). doi: 10.70352/scrj.cr.25-0156. Epub 2025 Aug 8.
Neoadjuvant gemcitabine plus S-1 (GS) therapy for resectable pancreatic cancer has been shown to prolong overall survival significantly compared with upfront surgery. Herein, we report two opposite cases of patients with resectable pancreatic cancer who underwent distal pancreatectomy after neoadjuvant GS therapy.
In Case 1, a 49-year-old female with a 12 mm tumor in the pancreatic body (cT1N0M0, cStage IA, union for international cancer control [UICC] 8th edition) underwent two courses of neoadjuvant GS therapy followed by an open distal pancreatectomy. Pathological examination revealed no residual cancer and the patient was diagnosed with a pathological complete response (pCR) without recurrence 31 months after surgery. However, in Case 2, a 74-year-old male with a 12 mm tumor in the pancreatic body (cT1N0M0, cStage IA, UICC 8th edition) also underwent two courses of neoadjuvant GS therapy, and then a laparoscopic distal pancreatectomy was performed. Pathological examination showed invasive pancreatic ductal adenocarcinoma with a 20 mm tumor. The tumor exhibited invasion into the lumen of the splenic vein and retroperitoneal tissue (ypT1N0M0, ypStage IA, UICC 8th edition). Adjuvant chemotherapy with S-1 was started, but 4 months postoperatively, a significant rise in serum CA19-9 levels was observed with multiple hepatic metastases and portal venous tumor thrombus. Gemcitabine plus nab-paclitaxel (GnP) therapy was started, however, the tumor progressed rapidly. The patient died 6 months after surgery.
Neoadjuvant GS therapy is potentially expected to have a significant therapeutic effect as the pCR. Nevertheless, even after surgical resection, some patients still exhibit extremely poor prognosis. Therefore, it is necessary to clarify their clinical characteristics.
与直接手术相比，新辅助吉西他滨联合S-1（GS）疗法治疗可切除胰腺癌已被证明能显著延长总生存期。在此，我们报告两例可切除胰腺癌患者在新辅助GS治疗后接受胰体尾切除术的相反病例。
病例1中，一名49岁女性，胰体部有一个12毫米的肿瘤（cT1N0M0，c期IA，国际癌症控制联盟[UICC]第8版），接受了两个疗程的新辅助GS治疗，随后进行了开放性胰体尾切除术。病理检查显示无残留癌，患者被诊断为病理完全缓解（pCR），术后31个月无复发。然而，病例2中，一名74岁男性，胰体部也有一个12毫米的肿瘤（cT1N0M0，c期IA，UICC第8版），同样接受了两个疗程的新辅助GS治疗，然后进行了腹腔镜胰体尾切除术。病理检查显示为浸润性胰腺导管腺癌，肿瘤大小为20毫米。肿瘤侵犯脾静脉腔和腹膜后组织（ypT1N0M0，yp期IA，UICC第8版）。开始使用S-1进行辅助化疗，但术后4个月，血清CA19-9水平显著升高，出现多处肝转移和门静脉肿瘤血栓。开始使用吉西他滨联合白蛋白结合型紫杉醇（GnP）治疗，然而，肿瘤进展迅速。患者术后6个月死亡。
新辅助GS疗法有望作为pCR产生显著的治疗效果。然而，即使在手术切除后，一些患者的预后仍然极差。因此，有必要明确他们的临床特征。
