Borderline resectable pancreatic cancer treated by pancreaticoduodenectomy with splenic artery resection (PD-SAR) after neoadjuvant chemotherapy: a case report

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  • 術前化学療法後に脾動脈合併膵頭十二指腸切除術を施行したborderline resectable膵癌の1例

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<p>A 68-year-old man presented with hydronephrosis. Computed tomography scan showed a tumor with invasion of the portal vein and splenic artery from the pancreatic head to the body. Histological examination of EUS-FNA specimens confirmed adenocarcinoma. The diagnosis was cStage IIA borderline resectable pancreatic carcinoma, cT3N0M0. He was treated with 2 courses of neoadjuvant chemotherapy (Gemcitabine plus Nab-paclitaxel (GnP) ). The primary tumor reduced in size by 21% after 2 courses of GnP which was no longer invading the portal vein or splenic artery. He then underwent pancreaticoduodenectomy with splenic artery resection (PD-SAR), because it was difficult to separate the tumor from the splenic artery. The pathological diagnosis was pStage IIB invasive ductal carcinoma (pT3, N1b (4/23), M0, TS1 (15mm), sci, INFc, ly1, v1, ne1, mpdX, pCH0, pDU0, pS1, pRP1, pPV1 (PVsp), pA0, pPLX, pPCMX, pBCM0, pDCM0 pDM0) and the therapeutic effect was grade1b. He received adjuvant chemotherapy using S1 but has a local recurrence 2 years after surgery, and was treated with GnP again after radiation therapy. Even in patients with invasion of the splenic artery requiring total pancreatectomy, PD-SAR may be a promising surgical strategy which maintains postoperative quality of life, residual pancreatic function and a radical resection.</p>

Journal

  • Suizo

    Suizo 36 (2), 188-194, 2021-04-30

    Japan Pancreas Society

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