Preoperative Chemoradiation and Pancreaticoduodenectomy with Portal Vein Resection for Localized Advanced Pancreatic Cancer.
10.3349/ymj.2003.44.3.551
- Author:
Yoon Seok CHAE
1
;
Jin Sub CHOI
;
Kyung Sik KIM
;
Jin Sil SEONG
;
Woo Jung LEE
;
Byong Ro KIM
Author Information
1. Department of Surgery and Radiation Oncology, Yonsei University College of Medicine, 134 Shinchon-dong, Seodaemun-gu, Seoul 120-752, Korea. wjlee@yumc.yonsei.ac.kr
- Publication Type:Case Report ; Review
- Keywords:
Chemoradiation therapy;
pancreatic cancer
- MeSH:
Adenocarcinoma/diagnosis/drug therapy/radiotherapy/*surgery;
Combined Modality Therapy;
Human;
Magnetic Resonance Imaging;
Male;
Middle Aged;
Pancreatic Neoplasms/diagnosis/drug therapy/radiotherapy/*surgery;
*Pancreaticoduodenectomy;
*Preoperative Care
- From:Yonsei Medical Journal
2003;44(3):551-556
- CountryRepublic of Korea
- Language:English
-
Abstract:
Pancreatic adenocarcinoma is a common disease that is rarely cured. Surgical resection remains the only treatment modality that has a curative potential, although the majority of patients are unsuitable for resection at the time of diagnosis. Chemoradiation therapy prior to a pancreaticoduodenectomy ensures that a patient who undergoes a complete resection multimodality therapy, avoids a resection in patients who have a rapidly progressive disease, and allows radiation therapy to be given to well oxygenated cells before, surgical devasculation. This permits the chance of resection of an unresectable pancreatic cancer by downstaging. A patient with cytologic proof of localized adenocarcinoma of the pancreatic head received an intravenously chemoradiation (Taxol, 50 mg/m2 intravenously for 3 hours week on 5 cycles, of Gemcytabine 1000 mg/m2/day intravenously for 3 days week on 2 cycles, of 4500 cGy) with the intention of proceeding to a resection operation, restaging was performed by computed tomography, magnetic resonance imaging from 5 weeks every months due to ongoing decreasing of tumor size after the chemoradiation. At laparotomy, the patient didn't have suspected metastatic disease, the tumor size was 2 x 3 cm on the pancreas head and was infiltrating into the portal vein for about 3 cm length on right side. A pancreaticoduodenectomy along with a portal vein and superior mesenteric vein resection was done and then reconstruction of a vascular anastomosis by using the right side of the internal jugular vein. Perioperative complications didn't occur. In conclusion, preoperative chemoradiation of a localized advanced pancreatic tumor has no added risk to the operative complications and the prospects for resectability are enhanced.
