Putu Niken Ayu Amrita and Siprianus Ugroseno Yudho Bintoro (2019) Management strategy for an advanced head of pancreas carcinoma patient with obstructive jaundice. Drug Invention Today, 13 (6). pp. 893-895. ISSN 09757619

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Abstract

Background: Pancreatic cancer (PC) is still considered incurable, with overall survival 3–5 months and 5-year survival 3% in advanced stage. Obstructive jaundice often complicates head of pancreas carcinoma. Strategy for bile diversion and chemotherapy regimen choices is needed to prolong survival and good quality of live. Case: Male, 64 years old, with abdominal discomfort and jaundice. Abdominal CT scan showed caput pancreas mass 43 mm ×39 mm attached to common mesenteric artery. The FNAB showed adenocarcinoma pancreas well differentiated. The diagnosis of PC adenocarcinoma well-differentiated T3N1M0 Stage III was made. Metal stent placement by ERCP to diverse bile. Chemotherapy with gemcitabine and carboplatin for six cycles, results in stable disease. The patient still has good performance status (PS 0-1), so second line chemotherapy regimen with 5- fluorouracyl, folinic acid, and oxaliplatin were given for 6 cycles. In month 15, the patient wished for oral chemotherapy, and capecitabine was given. His condition deteriorated with peritoneal metastase. The patient passed away in month 26 due to pneumonia and sepsis. Discussion: In locally advanced PC, resectability assessment is important. With mesenteric artery contact, resection is impossible. Endoscopic placement of a metallic biliary stent is strongly recommended for diversion. First-line chemotherapy of gemcitabine carboplatin can be given for fit patients. In refractory stage, second-line 5 fluorouracyl, folinic acid, and oxaliplatin significantly extend overall survival. Conclusion: Management strategy in advanced pancreatic carcinoma is important due to the poor prognosis nature. Bile diversion and prompt chemotherapy regimen choice can prolong survival and improve patient’s quality of live

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