-Case Reports-

Conversion Surgery for Metastatic Pancreatic Mucinous Carcinoma Responsive to Systemic Chemotherapy with Modified FOLFIRINOX: A Case Report

Tadashi Yokoyama¹, Hiroshi Makino¹, Atsushi Hirakata¹, Junji Ueda¹, Hideyuki Takata¹, Mikihiro Okusa¹, Manpei Kawashima¹, Takeshi Tsujino^2,3, Masaru Hosone⁴, Akira Matsushita⁵, Yoshiharu Nakamura⁵ and Hiroshi Yoshida⁵

¹Department of Surgery, Tama Nagayama Hospital, Nippon Medical School, Tokyo, Japan
²Department of Gastroenterology, Tama Nagayama Hospital, Nippon Medical School, Tokyo, Japan
³Miyuki Clinic, Tokyo, Japan
⁴Department of Pathology, Tama Nagayama Hospital, Nippon Medical School, Tokyo, Japan
⁵Department of Gastroenterological Surgery, Nippon Medical School, Tokyo, Japan

We report a case of metastatic pancreatic-head mucinous carcinoma (with multiple lymph node and bone metastases) and review the relevant literature. Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) was useful for diagnosis, and a satisfactory outcome was achieved after systemic chemotherapy with FOLFIRINOX followed by resection of the primary lesion as conversion surgery. The patient was a 55-year-old man. Hematological findings included elevated serum tumor marker levels: CEA 12.7 ng/mL, DUPAN-2 400 U/mL. Findings from several imaging modalities and EUS-FNA confirmed a clinicopathological diagnosis of metastatic pancreatic mucinous carcinoma with multiple bone and lymph node metastases. Five courses of modified FOIFIRINOX (m-FFX) were given as systemic chemotherapy, which had an antitumor effect. Subtotal stomach-preserving pancreaticoduodenectomy and extensive lymph-node dissection were thus performed. Histopathological analysis showed invasive ductal carcinoma, muc (pT3, pN1b, cM1). After surgery, the clinical course was notable for the absence of complications. Tegafur/gimeracil/oteracil (S-1) was started as maintenance adjuvant chemotherapy postoperatively, and no disease progression has been observed at 10 months after surgery.

J Nippon Med Sch 2019; 86: 284-290

Keywords
pancreatic mucinous carcinoma, modified FOLFIRINOX, conversion surgery

Correspondence to
Tadashi Yokoyama, MD, Department of Surgery, Nippon Medical School Tama Nagayama Hospital, 1-7-1 Nagayama, Tama, Tokyo 206-8512, Japan
yokotada@nms.ac.jp

Received, October 20, 2018
Accepted, April 9, 2019