An Enhanced Multimodality Treatment Strategy in Pancreatic Ductal Carcinoma Requiring Heminephrectomy for Radical Resection - A Case Report

A 76-year-old male visited a clinic and the images incidentally revealed a tumor in the tail of pancreas. Pancreatic ductal adenocarcinoma was diagnosed by the following examination, indicating that the tumor invasion to spleen, left adrenal gland and left kidney(cT3N0M0, cStage II A), requiring heminephrectomy for radical resection. Enhanced preoperative treatments were performed while taking into account a possibility of any restrictions for the age and the standard adjuvant chemotherapies after heminephrectomy. Although the direct tumor invasion to other organs still remained, we found the significant reductions of tumor size and FDG uptake level with the decrease of serum tumor marker levels without an appearance of distant metastasis and another disease, so a radical surgery was performed. We performed distal pancreatectomy with left heminephrectomy and left adrenalectomy. The histopathological findings showed pathological stage was ypT3N1aM0, fStage II B with the direct invasion to the spleen and left adrenal gland with the effect of preoperative therapy as Grade II b in Evans classification. He has survived so far without recurrence for 11 months after surgery without operative complications.