Successful conversion surgery for patients with pancreatic cancer, positive peritoneal cytology, and liver metastasis who were treated with chemotherapy involving nanoliposomal irinotecan with fluorouracil and folinic acid.

Abstract

A 67-year-old woman was diagnosed with pancreatic head cancer. Staging laparoscopy (SL) was performed, peritoneal cytology (CY) was positive (CY1), and a peritoneal access port was created. The patient was started on nab-paclitaxel plus gemcitabine therapy (GnP). After 6 courses of GnP therapy, computed tomography revealed a single metastatic tumour in the liver. The disease was considered advanced, and nal-IRI + 5-FU/LV therapy was initiated as second-line treatment. After 13 courses of treatment, both the liver nodule and the primary tumour decreased in size, and CY became negative (CY0). A second-look SL and partial resection of the metastatic liver were performed. Thereafter, after 7 additional courses of nal-IRI + 5-FU/LV therapy. A third-look SL revealed no distant metastasis, and CY0. Then, pancreatoduodenectomy was performed as the conversion surgery. Histological examination revealed Grade 1a disease. She resumed adjuvant chemotherapy and is alive 7 months postoperatively without any signs of recurrence. In our rare case, a patient with CY1 pancreatic cancer and liver metastasis was successfully treated with nal-IRI + 5-FU/LV and was able to undergo radical resection. To our knowledge, this is the first report on conversion surgery with this regimen, which is not considered to have a high response rate.