Successful treatment with conversion surgery following chemoradiotherapy for unresectable invasive intraductal papillary mucinous neoplasm
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Recent advances in chemotherapy and chemoradiotherapy (CRT) have enabled the use of conversion surgery in selected patients with initially unresectable pancreatic duct adenocarcinoma after a favorable response to preoperative treatment. However, conversion surgery for invasive intraductal papillary mucinous neoplasm (IPMN) has not been reported.
A 63-year-old man was referred to our hospital for invasive IPMN treatment. Computed tomography revealed a multilocular tumor of 7.2 × 5.8 cm in diameter, which surrounded approximately 180° of the superior mesenteric artery and totally occluded the superior mesenteric vein (SMV). He was diagnosed with unresectable invasive IPMN. CRT was performed using four cycles of S-1 (100 mg/day) based on body surface area for 14 days every 3 weeks plus gemcitabine 1,000 mg/m2 on days 8 and 15 with concurrent radiotherapy (50.4 Gy in 28 fractions). Response to chemotherapy revealed partial response according to the Response Evaluation Criteria in Solid Tumors; subsequently, subtotal stomach-preserving pancreaticoduodenectomy with SMV resection was performed. The postoperative course was uneventful. Four courses of adjuvant chemotherapy with TS-1 100 mg / day were administered postoperatively. At 5 years and 9 months after initiating treatment, the patient was alive without recurrence.
KeywordsInvasive IPMN Conversion surgery Chemotherapy
Pancreatic duct adenocarcinoma
Endoscopic ultrasound fine-needle aspiration
Intraductal papillary mucinous neoplasm
Superior mesenteric vein
Branched pancreatic duct type intraductal papillary mucinous neoplasm
National Comprehensive Cancer Network
I would like to express my sincere appreciation to Prof. Akio Yanagisawa of the Kyoto Prefectual University, Dr. Akiko Matsuzaki and Dr. Tomoko Tamaki of the University of the Ryukyus for advice on pathological diagnosis.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
All procedures followed have been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.
Informed consent was obtained from the patient for being included in the study.
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