A woman in her 40s was hospitalizedfor jaundice. Six years before, she hadbeen diagnosedwith synchronous esophageal andgastric cancers andhadund ergone subtotal esophagectomy andtotal gastrectomy, accompaniedby reconstruction with the pedicled jejunum. Multimodal imaging revealed a tumor at the pancreatic head, probably pancreatic cancer, which induced severe stenosis of the intrapancreatic bile duct. Scraping cytology findings of the lesion via the percutaneous transhepatic cholangial drainage(PTCD)route strengthenedthe suspicion. In the image, although no obvious invasion of the major vessels or apparent distant metastases were detected, an abnormal shadow was found continuously lining the main tumor andpara -aortic region, which was a contraindication for curative resection. Therefore, we performed neoadjuvant chemotherapy with gemcitabine plus S-1. After 3 courses, the lesion size reduced notably, and pancreatoduodenectomy was performed. The pathological diagnosis was pancreatic cancer(ph, ypT3, ypN1a, ypM0, ypStage ⅡB). Except for pancreatic fistulas(Clavien-Dindo Ⅲa), the postoperative clinical course was uneventful, andshe was dischargedon postoperative day 27. To date, the patient is alive without recurrence and is undergoing adjuvant chemotherapy with S-1.