[A Case of Pancreaticoduodenectomy Performed after Chemotherapy and Arterial Embolization for a Giant Duodenal GIST in a Jehovah's Witness].

We report a case of pancreaticoduodenectomy for a giant duodenal gastrointestinal stromal tumor(GIST)that was safely resected without a blood transfusion using chemotherapy and arterial embolization preceded by perioperative management with patient blood management(PBM). The patient was a 73-year-old female Jehovah's Witness. The patient presented to her primary care physician 6 months earlier with a chief complaint of jaundice. A computed tomography scan revealed a tumor measuring 113.7×96.2 mm extending from the pancreatic head to the porta hepatis. Upper gastrointestinal endoscopy revealed SMT lesions in the duodenal bulb and descending leg, which were biopsied, and a diagnosis of duodenal GIST was reached. The patient underwent preoperative chemotherapy with Gleevec, and surgery was planned approximately 6 months after the start of treatment to reduce the tumor size. The tumor size was reduced to 87.5×56.0 mm. Iron and vitamin supplements were also administered for a set period as hemostatic therapy, and the hemoglobin concentration increased to 12.6 g/dL immediately before surgery. To control intraoperative bleeding, the gastroduodenal artery was embolized using celiac artery angiography, and pancreatoduodenectomy was performed 9 days later. In this case, we incorporated preoperative chemotherapy, and perioperative management consisted of tumor embolization and PBM to preserve the blood supply. This allowed us to complete the treatment without blood transfusion, respecting patient autonomy.