Conversion surgery for initially unresectable pancreatic ductal adenocarcinoma with synchronous liver metastasis after treatment with FOLFIRINOX

  • Kentaro Ozaki
  • Hiromitsu Hayashi
  • Yoshiaki Ikuta
  • Toshiro Masuda
  • Shinichi Akaboshi
  • Kenichi Ogata
  • Katsutaka Matumoto
  • Katsuhiro Ogawa
  • Takihiro Kamio
  • Hideo Baba
  • Hiroshi TakamoriEmail author
Case Report


FOLFIRINOX is a highly effective anticancer treatment, even in advanced pancreatic cancer, which provides a potential cure in patients initially treated with a palliative strategy. A 47-year-old man was found to have an unresectable pancreatic cancer (4 cm in size) surrounding both the superior mesenteric artery and superior mesenteric vein. A simultaneous liver metastasis in Segment 8, with a diameter of 17 mm, was also detected. The pancreatic tumor markers CEA, CA19-9, and DUPAN-2 were significantly elevated to 21.7 ng/mL, 6224 ng/mL, and 1200U/mL, respectively. After 21 courses of FOLFIRINOX, the primary pancreatic tumor diminished in size (partial response) from 42 to 17 mm, and the liver mass almost disappeared. The tumor markers significantly decreased to almost normal levels. Fourteen months after the initial chemotherapy, conversion surgery was performed. Upon surgical resection, the pancreatic tumor was found to be Grade 1b, and a pathologically complete response was observed for the liver metastasis. The patient is still alive 32 months after initial treatment with no recurrence. This is an informative case of a locally advanced pancreatic cancer with a synchronous liver metastasis that had a significant response to FOLFIRINOX, allowing for subsequent curative resection.


Pancreatic cancer Conversion surgery FOLFIRINOX 



Multi-detector computed tomography


Positron emission tomography–computed tomography


Uridine diphosphate glucuronosyltransferase


Authors’ contributions

KO, HH, YI, SA, and HT performed the operation. HH and HT determined the treatment plan. HB and TK provided critical review of clinical findings. All other authors made a round of visits after the operation. All authors read and approved the final manuscript.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflicts of interest concerning this article.

Human and animal rights

All procedures followed have been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

Ethical approval

Written informed consent was obtained from the patient for publication of this Case Report and any accompanying images.

Informed consent

Informed consent was obtained for this case report.


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Copyright information

© Japanese Society of Gastroenterology 2019

Authors and Affiliations

  • Kentaro Ozaki
    • 1
  • Hiromitsu Hayashi
    • 1
    • 3
  • Yoshiaki Ikuta
    • 1
  • Toshiro Masuda
    • 1
  • Shinichi Akaboshi
    • 1
  • Kenichi Ogata
    • 1
  • Katsutaka Matumoto
    • 1
  • Katsuhiro Ogawa
    • 1
  • Takihiro Kamio
    • 2
  • Hideo Baba
    • 3
  • Hiroshi Takamori
    • 1
    Email author
  1. 1.Department of SurgerySaiseikai Kumamoto HospitalKumamotoJapan
  2. 2.Department of PathologySaiseikai Kumamoto HospitalKumamotoJapan
  3. 3.Department of Gastroenterological SurgeryKumamoto UniversityKumamotoJapan

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