Fig. 4.

Operative findings and macroscopic observation. The lymph node metastases are adjacent to the pancreas and splenic artery in Case 2, or to the caudate lobe and common hepatic artery in Case 3; however, these were successfully dissected. The area between the tumor and pancreas shows only edematous changes in Case 5. The tumor invaded the liver, and it was necessary to perform a partial liver resection in Case 4. Macroscopic observation reveals tumor shrinkage in all cases. *Case 5 achieved Grade 3 effect (pCR: pathologically complete response)