Abstract
BackgroundTherapeutic outcomes and prognosis of primary unresectable duodenal cancer remains unsatisfactory, because effective chemotherapy is not established.Case presentationA 71-year-old male diagnosed with unresectable duodenal carcinoma with distant lymph node metastases was judged inoperable (cT3N2M1 cStage in UICC7th). Duodenal obstruction developed due to tumor growth, and the patient underwent laparoscopic gastro-jejunostomy and then combined chemotherapy using S-1 and cisplatin. Abdominal CT revealed reduction of the tumor, and lymph node swelling almost disappeared after chemotherapy.He underwent subtotal stomach-preserving pancreaticoduodenectomy and lymph node dissection including the para-aortic region. The final stage was fT3N1M0, StageIIIA in UICC7th. He developed pancreatic fistula (ISGPF grade B), which subsided, and he was discharged 29 days after operation. He underwent adjuvant chemotherapy using S-1 for 1 year, and he remains well without recurrence.ConclusionsS-1/cisplatin combination chemotherapy allowed R0 resection for advanced duodenal cancer.
Highlights
Therapeutic outcomes and prognosis of primary unresectable duodenal cancer remains unsatisfactory, because effective chemotherapy is not established.Case presentation: A 71-year-old male diagnosed with unresectable duodenal carcinoma with distant lymph node metastases was judged inoperable
We report a case of successful radical resection of an initially unresectable duodenal cancer that became operable after chemotherapy using S-1 and cisplatin
We consider that advanced duodenal cancer with lymph node metastases was poor prognosis
Summary
Surgical resection is the only potentially cure treatment for advanced duodenal cancer. Approximately 25% of advanced duodenal cancer cases are unresectable at the time of diagnosis [1]. We report a case of successful radical resection of an initially unresectable duodenal cancer that became operable after chemotherapy using S-1 and cisplatin. Upper gastrointestinal endoscopy revealed advanced primary duodenal cancer located in the second portion of the duodenum. Duodenal cavity was completely obstructed by type 2 tumor located in the second portion of the duodenum (55 × 45 × 10 mm) (Fig. 6). Distended changes and hydropic degeneration of nucleus were observed, and cancer cells were not detected in the No. and 16 lymph nodes These pathological changes were considered to be induced by chemotherapy, and the pathological grade was determined to be grade 2a (Fig. 7). The patient received adjuvant chemotherapy using S-1 for 1 year and remains well for 1 year without recurrence after operation
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