Management of a Patient With Borderline Resectable Pancreatic Cancer

ABSTRACT: The definition and management of borderline resectability for periampullary pancreatic adenocarcinoma are evolving. In this case report, we discuss the presentation, workup, and therapeutic management of a 40-year-old man who presented with borderline resectable, periampullary pancreatic cancer and underwent a margin-negative resection following neoadjuvant chemoradiotherapy.

The definition of borderline resectability for periampullary pancreatic cancer and the treatment of this condition are evolving. In this installment of Clinical Quandaries, we present the case of a 40-year-old man with the diagnosis of borderline resectable (BR) adenocarcinoma of the pancreas, discuss his treatment course, and review the relevant literature.

Case Reports

Presentation and Workup

A 40-year-old man presented to his primary care physician with a history of abdominal pain for several months and weight loss of 20 lb, which was 9% of his usual adult weight. Shortly before presentation, he experienced jaundice, dark urine, light-colored stools, and generalized pruritus.

The patient’s past medical history was notable only for nephrolithiasis. He was taking no medications and had no known drug allergies. He denied clinically significant alcohol intake or use of either tobacco or illicit drugs. His family history was significant for a paternal uncle with colon cancer and a maternal nephew with leukemia of unknown type. He had no family history of pancreatic cancer. On physical examination, his vital signs were stable, and his weight was 201 lb (20 lb below his baseline). Physical exam revealed significant jaundice, including scleral icterus. On abdominal exam, he had no tenderness or hepatosplenomegaly. His heart rate and rhythm were regular, and his lungs were clear to auscultation. His performance status on the Eastern Cooperative Oncology Group (ECOG) scale was 0.

FIGURE 1

Suspicious Lesion FIGURE 2

Further CT Findings

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