内容紹介
Conversion Surgery for Pancreatic Head Cancer with Peritoneal Dissemination Following Chemotherapy for Two Years―A Case Report
Summary
Here we report a case of pancreatic cancer(PC)with peritoneal dissemination, underwent conversion surgery following chemotherapy for 2 years. A 55-year-old woman was referred to our hospital for treatment of PC. Abdominal CT scan revealed 3.0 cm of a pancreatic head tumor with abutment of the portal vein and the hepatic artery, classified as borderline resectable. Staging laparoscopy(SL)showed positive peritoneal cytology(CY). Gemcitabine(Gem)plus S-1 therapy(GS)was performed. Ten months after initial GS, SL revealed the disseminated nodule and positive CY. The regimen was changed to Gem plus nab-paclitaxel therapy(Gem plus nab-PTX). Since right ovarian tumor was detected by CT scan 6 months after initial Gem plus nab-PTX, laparoscopic oophorectomy was performed. Histological findings showed positive CY and ovarian metastasis of PC. Afterward, Gem plus nab-PTX has been continued for 8 months. Since SL after 2 years from initial chemotherapy showed negative CY and no metastatic lesion, pancreaticoduodenectomy with portal vein resection was performed as conversion surgery. According to General Rules for the Study of Pancreatic Cancer the 7th edition by Japan Pancreas Society, histological findings showed ypT3, ypN0, R0, and Grade 1b of histological effect. The patient is alive without recurrence 6 months after the resection.
要旨
腹膜転移を伴う膵頭部癌に対して2年間の化学療法後にdown-stagingが得られ根治切除し得た症例を経験した。症例は55歳,女性。腹部CTで膵頭部に径3.0 cmの腫瘤を認め,総肝動脈に接触する切除可能境界膵癌に対して審査腹腔鏡(SL)を施行したところ,腹腔洗浄細胞診が陽性(CY1)であった。gemcitabine(Gem)+S-1併用療法(GS)を開始し,10か月後のSLで右下腹部に播種結節を認め,CY1であったことからGem+nab-paclitaxel療法(Gem+nab-PTX)に変更した。6か月後のCTで右卵巣に腫瘍を認め診断的腹腔鏡下右卵巣摘出術を施行し,組織学的に卵巣への転移と診断され,CY1であった。Gem+nab-PTXを継続し,GS開始から2年時のSLで,CYは陰性化し新規遠隔転移もないことから,亜全胃温存膵頭十二指腸切除術,門脈合併切除再建術を施行した。膵癌取扱い規約第7版に基づき組織学的にypT3,ypN0,cM1,Stage Ⅳ,R0切除,組織学的治療効果はGrade 1bと診断された。術後6か月無再発生存中である。
目次
Summary
Here we report a case of pancreatic cancer(PC)with peritoneal dissemination, underwent conversion surgery following chemotherapy for 2 years. A 55-year-old woman was referred to our hospital for treatment of PC. Abdominal CT scan revealed 3.0 cm of a pancreatic head tumor with abutment of the portal vein and the hepatic artery, classified as borderline resectable. Staging laparoscopy(SL)showed positive peritoneal cytology(CY). Gemcitabine(Gem)plus S-1 therapy(GS)was performed. Ten months after initial GS, SL revealed the disseminated nodule and positive CY. The regimen was changed to Gem plus nab-paclitaxel therapy(Gem plus nab-PTX). Since right ovarian tumor was detected by CT scan 6 months after initial Gem plus nab-PTX, laparoscopic oophorectomy was performed. Histological findings showed positive CY and ovarian metastasis of PC. Afterward, Gem plus nab-PTX has been continued for 8 months. Since SL after 2 years from initial chemotherapy showed negative CY and no metastatic lesion, pancreaticoduodenectomy with portal vein resection was performed as conversion surgery. According to General Rules for the Study of Pancreatic Cancer the 7th edition by Japan Pancreas Society, histological findings showed ypT3, ypN0, R0, and Grade 1b of histological effect. The patient is alive without recurrence 6 months after the resection.
要旨
腹膜転移を伴う膵頭部癌に対して2年間の化学療法後にdown-stagingが得られ根治切除し得た症例を経験した。症例は55歳,女性。腹部CTで膵頭部に径3.0 cmの腫瘤を認め,総肝動脈に接触する切除可能境界膵癌に対して審査腹腔鏡(SL)を施行したところ,腹腔洗浄細胞診が陽性(CY1)であった。gemcitabine(Gem)+S-1併用療法(GS)を開始し,10か月後のSLで右下腹部に播種結節を認め,CY1であったことからGem+nab-paclitaxel療法(Gem+nab-PTX)に変更した。6か月後のCTで右卵巣に腫瘍を認め診断的腹腔鏡下右卵巣摘出術を施行し,組織学的に卵巣への転移と診断され,CY1であった。Gem+nab-PTXを継続し,GS開始から2年時のSLで,CYは陰性化し新規遠隔転移もないことから,亜全胃温存膵頭十二指腸切除術,門脈合併切除再建術を施行した。膵癌取扱い規約第7版に基づき組織学的にypT3,ypN0,cM1,Stage Ⅳ,R0切除,組織学的治療効果はGrade 1bと診断された。術後6か月無再発生存中である。