Abstract
BackgroundPrimary duodenal adenocarcinoma (PDC) is a rare and lethal disease, and cases with nodal or distant metastasis have a poor prognosis. There are several reports of unresectable duodenal adenocarcinoma responding to systemic chemotherapy. However, there is little data on conversion surgery for PDC with distant metastasis.Case presentationWe report a 55-year-old man with unresectable PDC with liver and nodal metastases responding to systemic chemotherapy with capecitabine and oxaliplatin (XELOX). His metastatic lesions completely disappeared by 18-fluorodeoxyglucose positron emission tomography/computed tomography after six courses of XELOX. Then, he underwent pancreaticoduodenectomy with lymph node dissection and partial resection of the liver. Postoperatively, the histological effect was determined to be grade 3, and the patient was diagnosed as having achieved pathological complete response (pCR). He is disease-free with no evidence of metastatic lesion for 14 months after surgery. Conversion surgery allowed R0 resection for unresectable PDC, and pCR can be achieved with XELOX treatment.ConclusionTo the best of our knowledge, this case is the first report of conversion surgery for unresectable PDC with liver and para-aortic lymph node metastases.
Highlights
Primary duodenal adenocarcinoma (PDC) is a rare and lethal disease, and cases with nodal or distant metastasis have a poor prognosis
To the best of our knowledge, this case is the first report of conversion surgery for unresectable PDC with liver and para-aortic lymph node metastases
We report a very rare case of unresectable PDC with liver metastasis and para-aortic nodal metastasis that was successfully downgraded by systemic chemotherapy using six courses of capecitabine and oxaliplatin (XELOX) and conversion surgery
Summary
Primary duodenal adenocarcinoma (PDC) is a rare disease, and cases with nodal and distant metastases have a poor prognosis. We report a very rare case of unresectable PDC with liver metastasis and para-aortic nodal metastasis that was successfully downgraded by systemic chemotherapy using six courses of capecitabine and oxaliplatin (XELOX) and conversion surgery. Case presentation A 55-year-old man was referred to our hospital for jaundice and pruritus His laboratory tests showed elevated blood markers, with a γ-glutamyl transpeptidase (γ-GTP) level of 1330 U/L (normal range, 10–75 U/L) and a total bilirubin level of 2.5 mg/dL (normal range, 0.5–2.5 mg/dL). The patient suffered from grade A postoperative pancreatic fistula based on the International Study Group of Pancreatic Fistula definition, he was discharged from our hospital on postoperative day 32 without fatal complications He received capecitabine orally for 6 months and has been disease-free for 14 months after the surgery with no evidence of metastatic lesion
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