A long-term survival case treated with conversion surgery following chemotherapy after diagnostic metastasectomy for pancreatic cancer with synchronous liver metastasis

Mitsuhiro Shimura; Masamichi Mizuma; Hiroki Hayashi; Akiko Mori; Tomoyoshi Tachibana; Tatsuo Hata; Masahiro Iseki; Tatsuyuki Takadate; Kyohei Ariake; Shimpei Maeda; Hideo Ohtsuka; Naoaki Sakata; Takanori Morikawa; Kei Nakagawa; Takeshi Naitoh; Takashi Kamei; Fuyuhiko Motoi; Michiaki Unno

doi:10.1186/s40792-017-0409-9

A long-term survival case treated with conversion surgery following chemotherapy after diagnostic metastasectomy for pancreatic cancer with synchronous liver metastasis

Surg Case Rep. 2017 Dec 29;3(1):132. doi: 10.1186/s40792-017-0409-9.

Authors

Mitsuhiro Shimura¹, Masamichi Mizuma², Hiroki Hayashi¹, Akiko Mori¹, Tomoyoshi Tachibana¹, Tatsuo Hata¹, Masahiro Iseki¹, Tatsuyuki Takadate¹, Kyohei Ariake¹, Shimpei Maeda¹, Hideo Ohtsuka¹, Naoaki Sakata¹, Takanori Morikawa¹, Kei Nakagawa¹, Takeshi Naitoh¹, Takashi Kamei¹, Fuyuhiko Motoi¹, Michiaki Unno¹

Affiliations

¹ Department of Surgery, Graduate School of Medicine, Tohoku University, 1-1 Seiryomachi, Aobaku, Sendai, 980-8574, Japan.
² Department of Surgery, Graduate School of Medicine, Tohoku University, 1-1 Seiryomachi, Aobaku, Sendai, 980-8574, Japan. masamichi@surg.med.tohoku.ac.jp.

Abstract

Background: Pancreatic cancer with distant metastases is classified as "unresectable," for which the standard treatment is systemic chemotherapy. The effectiveness of radical resection for pancreatic cancer with distant metastases is unknown. Here, we report a case of long term survival treated with conversion surgery following chemotherapy after diagnostic metastasectomy for pancreatic cancer with synchronous liver metastasis.

Case presentation: A 73-year-old man was referred to our hospital to examine and treat for cancer of the pancreatic body. Computed tomography (CT) scan revealed a 26-mm hypovascular tumor in contact with the common hepatic artery (CHA) (> 180°), the celiac artery (< 180°), and portal vein at the pancreatic body. Resectability was determined as "borderline resectable." Two courses of gemcitabine plus S-1 combination therapy (GS) were administered as neoadjuvant chemotherapy (NAC). CT scan showed tumor shrinkage (21 mm), determined as stable disease (SD) according to Response Evaluation Criteria in Solid Tumors (RECIST). Although the abdomen was opened for radical resection, a small nodule on the liver was detected and removed. Since the nodule was diagnosed as adenocarcinoma by intraoperative frozen section, resection of the primary tumor was not performed. After three subsequent courses of GS therapy, no distant metastases were detected under radiological findings. Distal pancreatectomy with celiac artery resection (DP-CAR) was performed as radical surgery 6 months after the initial diagnosis. Histological diagnosis was well-differentiated tubular adenocarcinoma, showing ypT1 ypN1 M1 stage IV, negative surgical margin (R0), and grade III in the Evans classification. S-1 was administered every other day from 6 months after resection up to the present. The patient has been alive with no recurrence for 5 years after the initial diagnosis and 4.5 years after the resection.

Conclusion: There is a case that received survival benefits from conversion surgery following chemotherapy after diagnostic metastasectomy in pancreatic cancer with synchronous liver metastasis.

Keywords: Chemotherapy; Conversion surgery; Diagnostic metastasectomy; Liver metastasis; Pancreatic cancer.