Ishizaki Tetsuo, Abe Tomomi, Koyanagi Yasuhisa, Katsumata Kenji, Wada Tatehiko, Tsuchida Akihiko, Aoki Tatsuya
Dept. of Surgery, Atami Tokoro Memorial Hospital.
Gan To Kagaku Ryoho. 2007 Jun;34(6):945-8.
A case of colorectal cancer in a 60-year-old man became resectable after downstaging was achieved with mFOLFOX 6 for multiple liver metastases from colorectal cancer. The patient received 8 cycles of mFOLFOX 6 on the basis of a diagnosis of multiple liver metastases in the right and left lobes and a single metastasis in the right lung. After chemotherapy, the liver metastases showed partial response, and the lung metastasis stable disease. Because the lung metastasis was controlled and radical cure of the liver metastases was thought possible by resection, we performed right lobectomy of the liver. Postoperative progress was good, and we then planned a staged partial resection of the lung. However,on postoperative day 28, the patient was hospitalized again with liver dysfunction, which evolved into liver failure, in spite of conservative treatment. The patient died on postoperative day 95. The needle biopsy specimens of the liver taken on readmission showed bile duct occlusion, portal hypertension, and perisinusoidal fibrosis, and histopathology of the surgical non-tumoral liver specimen showed the same findings. We think that liver failure was triggered by resection of the liver which had been damaged by mFOLFOX 6. Recently, liver damage due to oxaliplatin was reported, and evaluation of liver injury is considered important before liver resection for colorectal liver metastases with neoadjuvant FOLFOX.
一名60岁男性的结直肠癌患者，在通过mFOLFOX 6方案使多发肝转移灶降期后变得可切除。该患者基于左右肝叶多发肝转移及右肺单个转移灶的诊断接受了8个周期的mFOLFOX 6治疗。化疗后，肝转移灶显示部分缓解，肺转移灶病情稳定。由于肺转移灶得到控制且认为通过手术有可能根治肝转移灶，我们对患者实施了肝右叶切除术。术后恢复良好，随后我们计划分阶段对肺进行部分切除术。然而，术后第28天，尽管进行了保守治疗，患者因肝功能障碍再次住院，最终发展为肝衰竭。患者于术后第95天死亡。再次入院时所取肝脏穿刺活检标本显示胆管闭塞、门静脉高压和窦周纤维化，手术切除的非肿瘤性肝脏标本的组织病理学检查也显示了相同结果。我们认为肝衰竭是由mFOLFOX 6造成损伤的肝脏切除所引发的。最近，有报道称奥沙利铂会导致肝损伤，对于接受新辅助FOLFOX治疗的结直肠癌肝转移患者，在肝切除术前评估肝损伤被认为很重要。
