[A Case of Remnant Pancreatic Cancer after Conversion Surgery for Advanced Distal Bile Duct Cancer Treated with Chemotherapy].

The patient was an 82-year-old man who received a total of 25 courses of GEM/CDDP therapy for unresectable distal bile duct cancer with multiple liver metastases. After the chemotherapy, no liver metastasis was detected on computed tomography. Then, he underwent pancreaticoduodenectomy(ⅡA-1, D2)as a conversion surgery(T2N0M0, fStageⅠB)at 2 years and 11 months after the initial diagnosis. Postoperatively, the patient received GEM therapy for 2 years and had no recurrence. Three years and 10 months after the surgery, computed tomography revealed a tumorous lesion with a poor contrasting effect on the remaining pancreas and a positive accumulation of SUVmax 8.6 was detected at the same site through the FDG-PET examination. We diagnosed the lesion as residual pancreatic cancer and performed remnant total pancreatectomy and splenectomy. The histopathological findings showed tumors arising from the residual pancreatic epithelium; therefore, we diagnosed his lesion as residual pancreatic cancer(T3N1aM0, fStage ⅡB). After the second surgery, he is being treated with adjuvant therapy with S-1 and is alive without recurrence. In this case, long-term survival was possible for 7 years and 4 months from the initial diagnosis of unresectable distal bile duct cancer. Metachronous double cancer of unresectable bile duct and pancreatic cancer is presumed to have a poor prognosis. However, long-term survival is suggested to be possible if multidisciplinary therapies are successful.