title: Radical Resection of a Primarily Unresectable Pancreatic Cancer After Neoadjuvant Chemotherapy Using Gemcitabine, TS-1, and Nafamostat Mesilate; Report of a Case.
abstract: A 58-year-old male visited his primary physician for epigastric and back pain. Abdominal-enhanced computed tomography (CT) revealed a hypovascular pancreatic tumor measuring 17 × 11 mm in the uncinate process of the pancreas extending into the superior mesenteric plexus for greater than 180°. With a diagnosis of unresectable pancreatic cancer, the patient received gemcitabine and TS-1 with arterial infusion of nafamostat mesilate. After 3 courses of chemotherapy, enhanced CT revealed a decrease in size of the pancreatic tumor with no lymph node and distant metastasis and improved invasion of the superior mesenteric plexus down to 120°. The patient underwent R0 pancreaticoduodenectomy. The patient made a satisfactory recovery without complications and was discharged on postoperative day 10. We herein report the first curative resected case of a primarily unresectable pancreatic cancer after neoadjuvant chemotherapy using gemcitabine, TS-1, and nafamostat mesilate.
authors.affiliation: Department of Surgery, The Jikei University School of Medicine, Tokyo, Japan.
authors.forename: Yuki
authors.initials: Y
authors.lastname: Fujiwara
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Shiba
authors.forename: Tadashi
authors.initials: T
authors.lastname: Uwagawa
authors.forename: Yasuro
authors.initials: Y
authors.lastname: Futagawa
authors.forename: Takeyuki
authors.initials: T
authors.lastname: Misawa
authors.forename: Katsuhiko
authors.initials: K
authors.lastname: Yanaga
mesh_terms: D000964:Antimetabolites, Antineoplastic / Q000008:administration & dosage*; D001550:Benzamidines; D003841:Deoxycytidine / Q000008:administration & dosage / Q000031:analogs & derivatives*; D006146:Guanidines / Q000008:administration & dosage*; D006801:Humans; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000379:methods*; D010190:Pancreatic Neoplasms / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D016577:Pancreaticoduodenectomy; D017640:Silicates / Q000008:administration & dosage*; D014025:Titanium / Q000008:administration & dosage*; D014057:Tomography, X-Ray Computed; D000093542:Gemcitabine
chemical_list: D000964:Antimetabolites, Antineoplastic; D001550:Benzamidines; D006146:Guanidines; D017640:Silicates; D003841:Deoxycytidine; C103828:titanium silicide; D014025:Titanium; C032855:nafamostat; D000093542:Gemcitabine
keywords: Down-staging; Nafamostat mesilate; Neoadjuvant chemotherapy; Unresectable pancreatic cancer