Total pancreatectomy of pancreatic cancer with slowly progressive type1 DM after chemotherapy of GEM+ Nab-paclitaxel

Abstract

Background: Total pancreatectomy is associated with short and long-termhigh complication rate such as malnutrition, indigestion, hyperglycemia and hypoglycemia due to endocrine and exocrine pancreatic insufficiency. Case: A 70-year-old female presented uncontrolled blood sugar with body weight loss during outpatient visit. Her medical problems are slowly progressive type1 diabetic mellitus for 8 years. Laboratory findings included elevated fasting prandial glucose of 282 mg/dl, HbA1c of 11.2%. A CT scan showed a 2cm mass in size in the body of pancreas, which was possibly invaded to the anterior pancreatic tissue and the retropancreatic tissue. There was no abutment on the mass to the portal vein or the superior mesenteric artery and vein. Based on these initial CT findings, this was a resectable pancreatic cody mass, which was diagnosed as T3N0M0 cStageIIA. However, she selected palliative chemotherapy with Gemcitabine +Nab-paclitaxel therapy, but not surgery, due to her age, performance status and comorbidity. After 2 cycles of chemotherapy, the primary tumor was reduced in size, diagnosed as PR. A classic pancreaticoduodenectomy was performed. Surgical pathology from the specimen showed a poorly differentiated infiltrating scirrhous adenocarcinoma of the pancreatic body. The tumor measured 2.5x2.0 x1.5 cm and invaded into the retropancreatic tissue, though all margins were negative with the closest margin being 0.3 cm. Angioperineural invasion was identified. No lymph nodes were negative for metastatic disease. The post operative staging was pT2N0 ypStageIB. Histological evaluation showed grade 1b response after neoadjuvant chemotherapy. After operation, there was no evidence of malnutrition and indigestion, and insulin dosage was reduced. Here we report a case of pancreatic cancer with slowly progressive type1 diabetic mellitus successfully treated by total pancretectomy after chemotherapy of Gemcitabine + Nab-paclitaxel.