A Case of Surgical Resection for Gallbladder Cancer with Para-Aortic Lymph Node Metastasis Following Neoadjuvant Chemotherapy with Gemcitabine, Cisplatin, and TS-1

A 60-year-old woman who visited a doctor during postoperative follow-up for breast cancer was found to have elevated CEA levels. Investigation with FDG-PET CT following enhanced CT suggested gallbladder cancer(GBC)accompanied with para-aortic lymph node(PAL)metastasis. Although we could not obtain any histological evidence, we recommended she be treated as a patient with advanced GBC, and she received 8 courses of chemotherapy consisting of gemcitabine, cisplatin, and TS-1, following the protocol of a clinical trial. After the chemotherapy, imaging exhibited down-staging of the GBC, indicating tumor shrinkage and disappearance of the accumulation of FDG at the tumor sites. We first performed cholecystectomy to obtain histological evidence, and subsequently performed pancreaticoduodenectomy and partial hepatectomy at the gallbladder bed. The pathological diagnosis was pT2N1M0, Stage III B, Evans Grade II b; curative grade A surgery was recommended because the PAL did not contain a tumor any more. The prognosis of advanced GBC with PAL metastasis is extremely poor, but conversion therapy with combined modality therapy including neoadjuvant chemotherapy is a useful strategy to achieve a curative resection.