Abstract
We report long-term survival of a patient who underwent conversion surgery after a long-term favorable response to S-1 plus intravenous and intraperitoneal paclitaxel therapy.
An 81-year-old man was diagnosed with pancreatic ductal adenocarcinoma in the pancreatic tail (34 mm diameter tumor and CA19-9; 831 U/ml) by endoscopic ultrasound fine needle aspiration cytology. Staging laparoscopy revealed peritoneal dissemination and positive peritoneal washings by cytology. After administration of S-1 combined with intravenous and intraperitoneal paclitaxel therapy, the patient's CA19-9 level (32.3 U/ml) and tumor size (10 mm in a diameter) decreased, and peritoneal washing cytology was negative. Second-look staging laparoscopy revealed resolution of the peritoneal nodules. Distal pancreato-splenectomy was then performed 12 months after initial treatment. The post-operative course was uneventful and the patient discharged on post-operative day 9. Pathological examination of the resected specimen revealed negative margins, pathologic stage T1 (1.0×0.5 mm)/N0/M0, stage I. The patient is alive and progression-free 48 months after initial treatment and 36 months after conversion surgery.
