Neoadjuvant double metal stent placement in a patient with locally unresectable cancer of the panceatic head—a case report

: Pancreatic cancer still has a poor prognosis and the only curative treatment that also leads to longest survival is surgical resection. However, due to poor performance status, locally advanced disease, or metastases only a minority of patients are candidates for surgery. On the other hand, newer and more potent neoadjuvant chemotherapy regimes may render locally advanced tumors resectable and when resection is achieved, resection results in improved prognosis. Cancer of the pancreatic head frequently cause biliary and duodenal obstruction that needs to be resolved prior to application of chemotherapy. Here we report the case of a 72-year-old patient who we diagnosed with cancer of the pancreatic head. At the time of diagnosis, cross-sectional imaging displayed no metastases. Histology of the tumor was confirmed by open surgery but the tumor was locally unresectable at the time of first exploration. Subsequently, the patient developed both jaundice and duodenal obstruction, therefore we performed “neoadjuvant” double metal stenting of the duodenum and the bile duct. The procedure involved an external-internal rendez-vous procedure that resulted in complete relief from biliary and gastric obstruction and enabled the patient to receive timely pre-operative chemotherapy.