Initially Unresectable Pancreas Cancer Treated with Adjuvant Surgery after Chemotherapy for Three Years and Nine Months from Initial Treatment

Abstract

The prognosis of metastatic or locally advanced pancreatic cancer is extremely poor. Results of neoadjuvant chemotherapy approaches for achieving improved resectability are currently unsatisfactory. We report a rare case of initially unresectable pancreas cancer treated by adjuvant surgery after chemotherapy for three years and nine months from initial treatment. A 73-year-old woman was admitted to our hospital for pancreatic tumor. Abdominal CT scan revealed a 2.5-cm mass in the pancreas head, which involved the common hepatic artery and celiac axis. Ultrasound-guided fine needle aspiration cytology was performed. Pathology revealed a well-differentiated pancreatic adenocarcinoma. We started chemotherapy using gemcitabine plus S-1, treating it as an unresectable locally advanced pancreatic cancer. After chemotherapy, follow-up images demonstrated loss of tumor clarity, allowing for R0 tumor resection. The patient underwent pancreaticoduodenectomy, with a negative margin status, 3 years and 9 months from initial treatment. Histologically, few atypical cells were detected in the resected specimens, and most of the tumor showed a fibrous change. She has been well without recurrence for 1 year and 4 months, and survives for more than 5 years from the initial treatment. Surgical intervention should be considered for unresectable locally advanced pancreatic cancer after a long-term favorable response to chemotherapy.