Resection of solitary metachronous lymph node metastasis from hepatocellular carcinoma following transarterial chemotherapy with cisplatin: a case report.

A 74-year-old female was found to have a 40-mm liver tumor (in segment VIII) by ultrasonography and was diagnosed with hepatocellular carcinoma (HCC). She underwent liver resection and was stably treated without recurrence for 19 months. A 45-mm extrahepatic tumor was then found during follow-up with enhanced computed tomography and was diagnosed as being a metachronous lymph node (LN) metastasis. Angiography revealed that the metastasis LN was fed by both the right and left gastric arteries. Transarterial chemotherapy with cisplatin was scheduled to control LN metastasis and to prevent intrahepatic metastasis, simultaneously. Blood alteration using coil embolization was performed to isolate the feeding arteries before transarterial chemotherapy with cisplatin powder. The patient was stably treated for 6 months (3 times) and no new intra- or extrahepatic metastatic lesions appeared during the chemotherapy. The patient subsequently underwent systematic LN dissection of the porta hepatis. She was successfully treated, and has remained recurrence-free for almost 5 years.