[A case of adjuvant surgery for a patient with initially unresectable locally advanced pancreatic cancer (LAPC) with a favorable response to S-1 chemotherapy].

Abstract

A 67-year-old man was admitted to our hospital with a complaint of epigastric discomfort. A 29-mm hypovascular tumor was detected in the head of the pancreas by abdominal computed tomography imaging. As the superior mesenteric artery (SMA) was also involved, we diagnosed the tumor as unresectable pancreatic cancer. With S-1 chemotherapy, a radiological partial response was seen. After 4 courses of chemotherapy, a subtotal-stomach-preserving-pancreatoduodenectomy with dissection of the nerve plexus surrounding the SMA was performed. Although the tissue surrounding the SMA was hard, invasion of the SMA was not detected. Microscopic investigation revealed a few moderately differentiated adenocarcinoma cells in the fibrous tissue and the nerve fibers of pancreas. No cancer cells were found at the edges of the surgical specimen. The patient underwent R0 resection and a pathological evaluation showed Grade III tumor according to the Evans classification. After surgery, S-1 was interrupted because of diarrhea and local recurrence appeared 4 months postoperatively. For improving the prognosis of patients with pancreatic cancers, surgical intervention is often performed in patients with initially unresectable pancreatic cancers who have "long-term" favorable responses to chemotherapy or chemoradiotherapy. However, because of the possibility of relatively good prognosis with nonsurgical treatment for such patients and also the demerits of surgical stress, it is important to carefully consider the adjuvant surgery option.

• Authors: Azusa Ueta, Hirochika Toyama, Tadahiro Goto, Ippei Matsumoto, Makoto Shinzeki, Sadaki Asari, Jun Ishida, Yoshihide Nanno, Daisuke Tsugawa, Kaori Kuramitsu, Motofumi Tanaka, Atsushi Takebe, Taro Okazaki, Masahiro Kido, Tetsuo Ajiki, Takumi Fukumoto, Tatsuya Okuno, Mayu Kokubun, Tomoo Ito, Yonson Ku
• Journal: Gan to kagaku ryoho. Cancer & chemotherapy (Gan To Kagaku Ryoho) Vol. 41 Issue 12 Pg. 2178-80 (Nov 2014) ISSN: 0385-0684 [Print] Japan
• PMID: 25731462 (Publication Type: Case Reports, English Abstract, Journal Article)

Chemical References

• Antimetabolites, Antineoplastic
• Drug Combinations
• S 1 (combination)
• Tegafur
• Oxonic Acid

Topics

• Antimetabolites, Antineoplastic
• Drug Combinations
• Humans
• Male
• Middle Aged
• Oxonic Acid (therapeutic use)
• Pancreatic Neoplasms (drug therapy, pathology, surgery)
• Recurrence
• Tegafur (therapeutic use)
• Treatment Outcome