Conversion surgery for initially unresectable carcinoma of the ampulla of Vater following pathological complete response to chemotherapy: a case report

Abstract

Background Carcinoma of the ampulla of Vater with distant metastases is regarded as unresectable. Systemic chemotherapy is basically the treatment of choice for such tumors. Case presentation A 68-year-old woman was referred to our hospital and diagnosed with carcinoma of the ampulla of Vater with lymph node and multiple liver metastases. She underwent systemic chemotherapy with a combination of gemcitabine and cisplatin. After 19 months of treatment, the primary tumor and liver metastases were difficult to detect on follow-up images. Shrinkage of the enlarged lymph nodes was also confirmed. Surgical resection was performed with curative intent after a multidisciplinary meeting. Pathological examination of the resected specimen showed no residual tumors. Systemic chemotherapy achieved a pathological complete response. The postoperative course was uneventful, and the patient remained free of recurrent disease at 10 months of follow-up. Conclusion This case shows the possibility of conversion surgery after systemic chemotherapy for carcinoma of the ampulla of Vater.

Prospects for Neoadjuvant Treatment of Ampullary Cancer

“…Postoperative complications account for 22-67%, mortality -0-9% [1,2,3]. Overall survival in observations where the R0 operation was performed: median -30.1-113 months, 1-year -75-86.7%, 3-year -57.3-69.4%, 5-year -20-88% [4,5,6,7,8].…”