CASE REPORT article
Front. Oncol.
Sec. Surgical Oncology
Volume 15 - 2025 | doi: 10.3389/fonc.2025.1649080
This article is part of the Research TopicAdvances in Surgical Techniques and ML/DL-based Prognostic Biomarkers for Surgical and Adjuvant Therapies of Hepatobiliary and Pancreatic CancersView all 7 articles
Sequential PTCD and Biliary Seed Stent Combined with Targeted-Immunotherapy for Advanced Pancreatic Cancer with Malignant Obstructive Jaundice: A Multidisciplinary Approach
Provisionally accepted
- 1Department of Emergency Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
- 2Vascular Surgery, The Sixth Hospital of Wuhan, Affiliated Hospital of Jianghan University, Wuhan 430015, China
- 3Department of Integrated Traditional Chinese and Western Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
- 4Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology,, Wuhan 430022, China
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Malignant obstructive jaundice (MOJ) due to tumor compression or invasion of the bile duct carries a grave prognosis. We report a case of a 54-year-old female patient (height: 160 cm, weight: 55 kg, BMI: 21.5 kg/m² , ECOG performance status: 1, with type 2 diabetes mellitus) advanced pancreatic head cancer causing MOJ, managed with a multidisciplinary approach. successfully managed with percutaneous transhepatic cholangial drainage(PTCD) followed by biliary seed stent placement to relieve obstruction. Initial endoscopic retrograde cholangiopancreatography (ERCP) with an 8.5 Fr plastic stent failed due to occlusion after 20 days, leading to bilirubin rebound. Emergency percutaneous transhepatic cholangial drainage (PTCD) followed by biliary metal stent (8 mm × 80 mm) and iodine-125 seed implantation effectively relieved obstruction, reducing total bilirubin (TBIL) from 116.9 to 45.6 μmol/L within seven days. Subsequent tomotherapy (TOMO, 66 Gy to gross tumor volume) and a personalized regimen of S1 (tegafur, 20 mg/day), nimotuzumab, and pembrolizumab, following intolerance to gemcitabine + nab-paclitaxel (AG), achieved a 78% reduction in CA19-9 and sustained biliary patency. At one-year follow-up, TBIL was 18.2 μmol/L, direct bilirubin (DBIL) was 9.8 μmol/L, and the patient reported a good quality of life (Karnofsky score: 90). A stepwise, multidisciplinary treatment strategy-integrating radiosensitization, targeted therapy, and immune activation-extended the patient's survival beyond one year. This case demonstrates the efficacy of sequential PTCD, seed stent, and targeted-immunotherapy, offering a practical model for managing advanced pancreatic cancer with MOJ. This case highlights a practical approach to managing advanced pancreatic cancer with MOJ, offering valuable insights for clinical practice.
Keywords: Malignant obstructive jaundice, Pancreatic Cancer, Percutaneous transhepatic cholangial drainage, targeted-immunotherapy, Multidisciplinary strategy
Received: 18 Jun 2025; Accepted: 01 Aug 2025.
Copyright: © 2025 Li, Sun, Zhu, Li and Wang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Pindong Li, Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology,, Wuhan 430022, China
Li Wang, Department of Emergency Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
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