Staged Surgery for Synchronous Proximal Gastric Adenocarcinoma and Pancreatic Head Ductal Adenocarcinoma with an Early Favorable Outcome: A Case Report

Background. Synchronous primary gastric cancer and pancreatic ductal adenocarcinoma (PDAC) are uncommon, and published experience with their combined treatment is limited. Proximal gastric adenocarcinoma combined with pancreatic head PDAC presents a particular challenge because resection and reconstruction must address two anatomically separate primary tumors. Materials and methods. A 62-year-old man with poorly differentiated proximal gastric adenocarcinoma (cT3N0M0) and pancreatic head PDAC (cT3N1M0) received six cycles of neoadjuvant FOLFIRINOX. Preoperative ECOG performance status was 0. Treatment comprised proximal gastrectomy with D2 lymphadenectomy and double-tract reconstruction and, approximately 10 weeks later, pylorus-preserving pancreatoduodenectomy. Contrast-enhanced CT before the second stage showed no disease progression. Results. Intra-abdominal hemorrhage after proximal gastrectomy required relaparotomy. Histopathological examination confirmed microscopically negative resection margins (R0) for both tumors. Gastric tumor regression was Becker grade 3, indicating minimal or no regression; pancreatic regression was Modified Ryan score 3, indicating a poor or absent response. Six cycles of adjuvant modified FOLFIRINOX were reported. At the last reported follow-up, 10 months after the second operation, the patient had no evidence of progression and an ECOG performance status of 0. Conclusions. This case documents the technical feasibility of staged gastric and pancreatic resection after neoadjuvant chemotherapy in a patient with preoperative ECOG performance status 0, with histologically negative resection margins and an early favorable outcome despite a postoperative complication. The reported R0 status describes the morphological assessment of resection margins. Longer follow-up is required to assess durable disease control.