The case was a 36-year-old male whose chief complaints were
anorexia and
weight loss. Upper gastrointestinal endoscopy revealed circumferential
stenosis in the fourth portion of the duodenum, while CT revealed a
tumor with a diameter of 60 mm continuing as a single mass from the pancreatic body and tail to the fourth portion of the duodenum, and this was accompanied by findings that raised suspicions of circumferential invasion of the superior mesentric artery (SMA). Based on these results and biopsy, the patient was diagnosed with pancreatic and SMA invasion of
duodenal cancer that was considered to be unresectable. After performing
gastrojejunostomy, we administered DOC (40 mg/m2, day 1), CDDP (60 mg/m2, day 1), and S-1( 80 mg/m2, day 1-14) for 3 courses. The
tumor response was PR and the images indicated the SMA invasion was disappeared. We judged that the
tumor could be gone by a resection while preserving the SMA. In the surgical findings, the
tumor continued as a single mass from the pancreatic body and tail to the third portion of the duodenum, and the surrounding area exhibited marked
fibrosis. We performed a pancreatic tail resection along with combined resection of third and fourth portions of the duodenum, transverse colon and splenic flexure, and left adrenal gland. The case was diagnosed to be well-differentiated invasive ductal
pancreatic cancer with duodenal invasion.
Cancer invasion was not observed in any of the stripped surfaces surrounding the pancreas. The T3, N1, M0, fStage III antitumor effects were mildly effective. In this case, the treatment was initially started by considering the case as one of
duodenal cancer, but the final results of a pathological diagnosis revealed that it was
pancreatic cancer. However, either way, even though the case was unresectable before the
chemotherapy performed for
duodenal cancer was significantly effective for the
pancreatic cancer. Therefore, a resection became possible, and an R0 resection was also effective.