A case of curatively resected locally advanced cancer of the pancreatic body treated by distal pancreatectomy with en bloc celiac axis resection after neoadjuvant chemotherapy

A 68-year-old man with locally advanced pancreatic body cancer invading the celiac axis (CA, including common hepatic artery) and in contact with the superior mesenteric artery (SMA) underwent 2 courses of neoadjuvant chemotherapy (NAC); gemcitabine hydrochloride (GEM 1, 000 mg/m ², on day 1 and 15) and S-1 (100 mg/m ²/day, 2-weeks of continuous administration followed by 1-week rest). The tumor volume and the contact area to SMA were greatly diminished. All tumor markers were reduced. He underwent R0 resection by distal pancreatectomy with en bloc celiac axis resection (DP-CAR). After the surgery, he could continue adjuvant chemotherapy; (GEM 1, 000 mg/m ²) only twice because of malnutrition. Nine months later CT revealed local recurrence and multiple lung metastases. The patient died 371 days after surgery. Appropriate NAC can contribute to R0 resection in locally advanced pancreatic cancer.