Surgical Rsection after Chemoradiation Therapy in a Patient with Locally Advanced Pancreas Carcinoma: A Case Report

Masaaki Watanabe, Hirofumi Kamachi, Munenori Tahara, Hideki Yokoo, Kazuaki Nakanishi, Tosiya Kamiyama, Michiaki Matsushita and Satoru Todo

Department of General Surgery, Graduate School of Medicine, Hokkaido University

We report a case of resected locally advanced pancreatic adenocarcinoma after chemoradiation therapy. A 54-year-old man diagnosed elsewhere with locally advanced pancreas carcinoma was found in computed tompgraphy (CT) to have a pancreatic head lesion of 20 mm invading the plexus of the supramesenteric artery and to the portal vein system. We found no hepatic or distant metastasis. Based on these findings, we conducted radiation therapy (50.4 Gy/28 Fr) and chemotherapy (Gemcitabine at 200 mg/week, full dose, 1,000 mg) as neoadjuvant therapy. Reevaluation CT after chemoradiation therapy showed no changes around the lesion (SD) and no distant metastasis. Based on these findings, we conducted pancreaticoduodenectomy with portal vein reconstruction two months after the chemoradiation therapy was completed. Pathological finding showed that a small amount of moderately differentiated adenocarcinoma cells were scattered in fibrous tissue. The pathological diagnosis was p Stage IVa with plexus invasion and without portal or artery invasion. No metastasis was observed in the lymph nodes. The postoperative course was uneventful, and the man remains well without recurrence in the 12 months since surgery. Preoperative chemoradiation therapy is thus a treatment alternative for locally advanced pancreatic carcinoma.

Key words
chemoradiation therapy, pancreas carcinoma, neoadjuvant

Reprint requests
Masaaki Watanabe Department of General Surgery, Graduate School of Medicine, Hokkaido University
Kita15-Nishi7, Kita-ku, Sapporo, 060-8638 JAPAN

Accepted
April 25, 2007

To read the PDF file you will need Abobe Reader installed on your computer.