Radical Resection of a Locally Advanced Unresectable Pancreatic Adenosquamous Carcinoma after Treatment with Systemic Chemotherapy

A 64-year-old man visited our hospital because of weight loss and after being detected with a tumor in the pancreatic body and tail on abdominal ultrasonography at a nearby hospital. Abdominal contrast-enhanced CT revealed a 45 mm tumor with celiac artery invasion in the pancreatic body and tail. This case was diagnosed as unresectable pancreatic cancer. After 2 regimens of systemic chemotherapy(5 courses of gemcitabine plus nab-paclitaxel and 2 courses of S-1), CT revealed a partial response(ie, reduction in the tumor size). Therefore, distal pancreatectomy was performed with en bloc celiac axis resection, portal vein resection, and left adrenalectomy, as well as lymph node dissection. The pathological diagnosis was adenosquamous carcinoma, and R0 resection was achieved. The histological response was Grade 1b. However, the patient developed lung metastasis 16 months after surgery and liver metastasis 18 months after surgery; he died 33 months after starting treatment.