A Case of Unresectable Ampulla of Vater Carcinoma Successfully Treated with Conversion Surgery Following Sequential...

The criteria for indications and postoperative treatment strategies for conversion surgery in patients with unresectable ampulla of Vater carcinoma with distant metastasis have not been clarified. We present an unusual case of a patient with initially unresectable ampulla of Vater carcinoma with multiple liver metastases who underwent conversion surgery after treatment with durvalumab and gemcitabine plus cisplatin.

A 69-year-old male was found to have ampulla of Vater carcinoma with multiple liver metastases. A diagnosis of unresectable ampulla of Vater carcinoma was made, and the treatment plan was chemotherapy. After 12 cycles of gemcitabine, cisplatin, and S-1, the tumor did not shrink. Six cycles of gemcitabine, cisplatin, and durvalumab were then administered. The metastases were obscured on imaging; however, micrometastases were observed on the liver surface by staging laparoscopy. Six additional cycles of gemcitabine, cisplatin, and durvalumab were administered, and the disappearance of metastases was confirmed by staging laparoscopy. The patient then underwent conversion surgery with subtotal gastric-preserving pancreaticoduodenectomy. Pathology revealed a complete response, and radical resection was successfully performed. Immunostaining of tissue collected during endoscopic ultrasound-guided acquisition revealed less than 1% expression of programmed death ligand-1.

Sequential systemic chemotherapy including durvalumab is suggested as a useful future treatment option and may contribute to conversion surgery for unresectable ampulla of Vater carcinoma.