内容紹介
A Case of Long-Term Survival of the Pancreatic Tail Cancer with the Concomitant Small Liver Metastasis
Summary
We hereby report a case of long-term survival of the pancreatic tail cancer with a synchronous small liver metastasis. A 62-year-old male with pancreatic tail cancer was incidentally diagnosed with single tiny metastasis in the left medial section of the liver during the distal pancreatectomy. The lesion was also resected together with primary lesion. Since then, systemic chemotherapies such as gemcitabine(GEM)plus S-1 combination therapy, GEM alone therapy and S-1 alone therapy had been given to escape from recurrence. However, the recurrences were found in the liver at 21 months after surgery. Left hepatectomy was performed for metastatic lesions. Afterwards, proton radiation therapy was twice performed for the metastatic lesions in the liver which were unable to be removed by surgery alone. Partial resection of transverse colon was also needed to be performed for the bowel obstruction caused by recurrence on the surgical margin of the liver. Systemic chemotherapies including S-1 therapy, FOLFIRINOX therapy and GEM plus nab-paclitaxel therapy have been continued throughout his entire treatment history after recurrence. He has been keeping in good physical condition with these multidisciplinary therapies, even though 51 months have passed since the first evidence of liver metastasis was diagnosed.
要旨
今回われわれは,術中に診断された同時性微小肝転移を有する膵尾部癌症例に対して外科的切除を含めた集学的治療を施行し,長期生存中の1例を経験したので報告する。症例は62歳,男性。2012年11月膵尾部癌に対する膵体尾部切除術の際に肝内側区域に2 mm大の白色結節を指摘され,病理学的に膵癌肝転移と診断された。術後gemcitabine(GEM)+S-1併用(GS)療法,GEM単独療法,S-1単独療法を施行したがCA19-9の上昇を認め,初回手術から21か月後に肝転移を認めた。肝転移に対して肝左葉切除,陽子線療法2回を施行した。肝切除後局所再発による腸閉塞に対して局所腫瘍切除術,横行結腸部分切除術を施行した。腹膜播種や大動脈周囲リンパ節再発も出現したため,全身化学療法としてS-1単独療法,FOLFIRINOX療法,GEM+nab-paclitaxel(PTX)併用療法を施行した。集学的治療を行い,全身状態を維持して術後51か月生存中である。
目次
Summary
We hereby report a case of long-term survival of the pancreatic tail cancer with a synchronous small liver metastasis. A 62-year-old male with pancreatic tail cancer was incidentally diagnosed with single tiny metastasis in the left medial section of the liver during the distal pancreatectomy. The lesion was also resected together with primary lesion. Since then, systemic chemotherapies such as gemcitabine(GEM)plus S-1 combination therapy, GEM alone therapy and S-1 alone therapy had been given to escape from recurrence. However, the recurrences were found in the liver at 21 months after surgery. Left hepatectomy was performed for metastatic lesions. Afterwards, proton radiation therapy was twice performed for the metastatic lesions in the liver which were unable to be removed by surgery alone. Partial resection of transverse colon was also needed to be performed for the bowel obstruction caused by recurrence on the surgical margin of the liver. Systemic chemotherapies including S-1 therapy, FOLFIRINOX therapy and GEM plus nab-paclitaxel therapy have been continued throughout his entire treatment history after recurrence. He has been keeping in good physical condition with these multidisciplinary therapies, even though 51 months have passed since the first evidence of liver metastasis was diagnosed.
要旨
今回われわれは,術中に診断された同時性微小肝転移を有する膵尾部癌症例に対して外科的切除を含めた集学的治療を施行し,長期生存中の1例を経験したので報告する。症例は62歳,男性。2012年11月膵尾部癌に対する膵体尾部切除術の際に肝内側区域に2 mm大の白色結節を指摘され,病理学的に膵癌肝転移と診断された。術後gemcitabine(GEM)+S-1併用(GS)療法,GEM単独療法,S-1単独療法を施行したがCA19-9の上昇を認め,初回手術から21か月後に肝転移を認めた。肝転移に対して肝左葉切除,陽子線療法2回を施行した。肝切除後局所再発による腸閉塞に対して局所腫瘍切除術,横行結腸部分切除術を施行した。腹膜播種や大動脈周囲リンパ節再発も出現したため,全身化学療法としてS-1単独療法,FOLFIRINOX療法,GEM+nab-paclitaxel(PTX)併用療法を施行した。集学的治療を行い,全身状態を維持して術後51か月生存中である。