Case Report
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Feb 14, 2021; 27(6): 534-544
Published online Feb 14, 2021. doi: 10.3748/wjg.v27.i6.534
Pancreaticoduodenectomy after neoadjuvant chemotherapy for gastric cancer invading the pancreatic head: A case report
Masahiro Yura, Kiminori Takano, Kiyohiko Adachi, Asuka Hara, Keita Hayashi, Yuki Tajima, Yasushi Kaneko, Yoichiro Ikoma, Hiroto Fujisaki, Akira Hirata, Kumiko Hongo, Kikuo Yo, Kimiyasu Yoneyama, Reiko Dehari, Kazuo Koyanagi, Motohito Nakagawa
Masahiro Yura, Kiminori Takano, Kiyohiko Adachi, Asuka Hara, Keita Hayashi, Yuki Tajima, Yasushi Kaneko, Yoichiro Ikoma, Hiroto Fujisaki, Akira Hirata, Kumiko Hongo, Kikuo Yo, Kimiyasu Yoneyama, Motohito Nakagawa, Department of Surgery, Hiratsuka City Hospital, Hiratsuka 2540065, Kanagawa, Japan
Reiko Dehari, Department of Surgical Pathology, Hiratsuka City Hospital, Hiratsuka 2540065, Kanagawa, Japan
Kazuo Koyanagi, Department of Gastroenterological Surgery, Tokai University School of Medicine, Isehara 259193, Kanagawa, Japan
Author contributions: Yura M and Takano K performed the surgery and wrote the paper; Koyanagi K and Nakagawa M reviewed the manuscript; Dehari R contributed to pathological diagnosis; All other authors equally contributed to medical treatment; All authors were responsible for the revision of the manuscript and final approval for submission.
Informed consent statement: Written informed consent was obtained from the patient for publication of this case report and any accompanying images.
Conflict-of-interest statement: All authors declare no conflicts of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Masahiro Yura, MD, Doctor, Surgeon, Department of Surgery, Hiratsuka City Hospital, 1-19-1, Mihamihara, Hiratsuka 2540065, Kanagawa, Japan. myura@ncc.go.jp
Received: December 4, 2020
Peer-review started: December 4, 2020
First decision: December 24, 2020
Revised: January 6, 2021
Accepted: January 26, 2021
Article in press: January 26, 2021
Published online: February 14, 2021
Processing time: 63 Days and 5.8 Hours
Abstract
BACKGROUND

Pancreaticoduodenectomy (PD) for advanced gastric cancer is rarely performed because of the high morbidity and mortality rates and low survival rate. However, neoadjuvant chemotherapy for advanced gastric cancer has improved, and chemotherapy combined with trastuzumab may have a preoperative tumor-reducing effect, especially for human epidermal growth factor receptor 2 (HER2)-positive cases.

CASE SUMMARY

We report a case of successful radical resection with PD after neoadjuvant S-1 plus oxaliplatin (SOX) and trastuzumab in a patient (66-year-old male) with advanced gastric cancer invading the pancreatic head. Initial esophagogastroduodenoscopy detected a type 3 advanced lesion located on the lower part of the stomach obstructing the pyloric ring. Computed tomography detected lymph node metastasis and tumor invasion to the pancreatic head without distant metastasis. Pathological findings revealed adenocarcinoma and HER2 positivity (immunohistochemical score of 3 +). We performed staging laparoscopy and confirmed no liver metastasis, no dissemination, negative lavage cytological findings, and immobility of the distal side of the stomach due to invasion to the pancreas. Laparoscopic gastrojejunostomy was performed at that time. One course of SOX and three courses of SOX plus trastuzumab were administered. Preoperative computed tomography showed partial response; therefore, PD was performed after neoadjuvant chemotherapy, and pathological radical resection was achieved.

CONCLUSION

We suggest that radical resection with PD after neoadjuvant chemotherapy plus trastuzumab is an option for locally advanced HER2-positive gastric cancer invading the pancreatic head in the absence of non-curative factors.

Keywords: Pancreaticoduodenectomy; Gastric cancer; Neoadjuvant chemotherapy; Trastuzumab; Human epidermal growth factor receptor 2; Case report

Core Tip: Because of the high surgical risk and poor prognosis, pancreaticoduodenectomy (PD) is rarely performed for gastric cancer. However, due to advances in surgery and improvements in perioperative management, PD may be considered for gastric cancer to improve long-term survival. We present the successful case of radical resection with PD after neoadjuvant chemotherapy combined with trastuzumab for human epidermal growth factor receptor 2-positive locally advanced gastric cancer invading the pancreatic head without postoperative severe complication. This case suggests that radical resection with PD after neoadjuvant chemotherapy combined with trastuzumab is an option for locally advanced human epidermal growth factor receptor 2-positive gastric cancer invading the pancreatic head in the absence of non-curative factors.