Conversion surgery with gemcitabine plus nab-paclitaxel for locally advanced unresectable pancreatic cancer: A case report.
Conversion surgery with gemcitabine plus nab-paclitaxel for locally advanced unresectable pancreatic cancer: A case report.
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DOI：
10.3892/mco.2018.1688
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发表时间：
2018-10
影响因子：
1.2
通讯作者：
Ohtsuka M
中科院分区：
文献类型：
--
作者：
Okura R;Takano S;Yokota T;Yoshitomi H;Kagawa S;Furukawa K;Takayashiki T;Kuboki S;Suzuki D;Sakai N;Nojima H;Mishima T;Miyazaki M;Ohtsuka M
局部晚期不可切除（UR-LA）胰腺导管腺癌（PDAC）的标准治疗是放化疗。化疗-放疗后的手术（转换手术）被认为是一种有用的策略，并已用于UR-LA PDAC。目前的研究提出了一个43岁的妇女谁抱怨背痛的情况。放射学检查显示胰腺肿瘤与上级肠系膜动脉（SMA）周长接触>270度，并从上级肠系膜静脉（SMV）向门静脉（PV）延伸。内镜超声引导细针穿刺活检显示腺癌为病理诊断，患者被诊断为UR-LA PDAC。吉西他滨联合白蛋白结合型紫杉醇（GNP）治疗9个月12个疗程后，肿瘤对SMA和SMV的侵袭程度得到改善，癌抗原（CA）19-9水平下降。进行了胰管切除术和PV切除术，并使用左肾静脉移植物进行了重建。病理检查显示手术结果为R 0（无残留肿瘤）切除，患者在初次治疗后（术后9个月）存活19个月，但局部肿瘤复发。2015年3月至2016年2月期间，在千叶大学医院（千叶，日本）普外科共遇到10例UR-LA PDAC病例，其中进行了GNP治疗。包括本病例在内，11例病例中有6例（55%）接受了根治性切除的转换手术。Kaplan-Meier分析显示，接受转换手术治疗的患者的总生存期（OS）显著长于未接受转换手术治疗的患者（中位OS，22.5 vs 11个月; P=0.047，Wilcoxon检验）。CA 19 -9的最小降低为67%。总之，GNP治疗后的转换手术是UR-LA PDAC的理想选择。CA 19 -9水平的显著降低可能有助于确定正在考虑进行转换手术的UR-LA PDAC患者从药物转换为手术的时间。
The standard treatment for locally advanced unresectable (UR-LA) pancreatic ductal adenocarcinoma (PDAC) is chemo-radiotherapy. Surgery following chemo-radiotherapy (conversion surgery), has been considered a useful strategy and has been used for UR-LA PDAC. The current study presents the case of a 43-year-old woman who complained of back pain. A radiological examination revealed a pancreatic tumor in contact with >270 degrees of the superior mesenteric artery (SMA) perimeter, with invasion extending from the superior mesenteric vein (SMV) to the portal vein (PV). An endoscopic ultrasonography-guided fine needle aspiration biopsy revealed adenocarcinoma as the pathological diagnosis and the patient was diagnosed with UR-LA PDAC. Following 12 courses of combined gemcitabine plus nab-paclitaxel (GnP) for 9 months, the extent of tumor invasion to the SMA and SMV was improved and the level of cancer antigen (CA) 19-9 decreased. A pancreatoduodenectomy with PV resection and reconstruction using a left renal vein graft were performed. Pathological examination revealed that the operative outcome was R0 (no residual tumor) resection and the patient was alive 19 months after the initial treatment (9 months post surgery), however, there was local tumor recurrence. Between March 2015 and February 2016 a total of 10 cases of UR-LA PDAC were encountered at the Department of General Surgery, Chiba University Hospital (Chiba, Japan), in which GnP therapy was performed. Including the present case, 6 of the 11 cases (55%) underwent conversion surgery with curative resection. Kaplan-Meier analysis revealed that patients treated with conversion surgery presented significantly longer overall survival (OS) than those treated with no conversion surgery (median OS, 22.5 vs. 11 months; P=0.047, Wilcoxon test). The minimum reduction of CA19-9 was 67%. In conclusion, conversion surgery following GnP therapy is a desirable option for UR-LA PDAC. A significant reduction in the CA19-9 levels may be useful in determining the timing of changeover from medicine to surgery in patients with UR-LA PDAC in whom conversion surgery is being considered.