Kamada Teppei, Onda Shinji, Takano Yuki, Sakamoto Taro, Kikuchi Ryo, Yanaga Katsuhiko
Department of Surgery, The Jikei University School of Medicine, 3-25-8 Nishi-shimbashi, Minato-ku, Tokyo, 105-8461, Japan.
Department of Pathology, The Jikei University School of Medicine, 3-25-8 Nishi-shimbashi, Minato-ku, Tokyo, 105-8461, Japan.
Int J Surg Case Rep. 2020;71:319-322. doi: 10.1016/j.ijscr.2020.05.043. Epub 2020 May 29.
The prognosis of atypical pulmonary carcinoid with liver metastases is extremely poor, and patients with multiple liver metastases are often treated using non-surgical therapies. We report a case with multiple liver metastases from atypical pulmonary carcinoid that was successfully treated using two-stage hepatectomy combined with embolization of portal vein branches.
A 48-year-old man was referred to our department after multiple liver tumors were detected in both liver lobes on computed tomography. He had undergone right upper lobectomy of the lung for atypical pulmonary carcinoid (T2a, N0, M0; Stage IB) 2 years previously. Positron emission tomography-computed tomography showed no extrahepatic tumor manifestations. The tumors were located in segment 2, 3, 5/8 and the right hepatic vein drainage area. We planned complete resection of metastases in a two-stage hepatectomy. The first stage comprised concomitant left lateral segmentectomy, partial hepatectomy of segment 5/8 and portal vein embolization of the posterior segmental branches. The second stage comprised resection of the right hepatic vein drainage area, performed 21 days after the first surgery. Histopathological diagnosis was liver metastases of atypical pulmonary carcinoid. Postoperative bile leak developed, which was treated with endoscopic retrograde biliary drainage and percutaneous bile leak drainage. He has been followed for 24 months postoperatively without tumor recurrence.
Two-stage hepatectomy may represent an option for bilobar multiple liver metastases from atypical pulmonary carcinoid.
We successfully treated a patient with multiple liver metastases of atypical pulmonary carcinoid using a two-stage hepatectomy combined with portal vein embolization of the posterior segmental branches.
非典型肺类癌伴肝转移的预后极差，多发肝转移患者常采用非手术治疗。我们报告1例非典型肺类癌多发肝转移患者，经两期肝切除术联合门静脉分支栓塞成功治疗。
一名48岁男性在计算机断层扫描发现双侧肝叶多发肝肿瘤后转诊至我科。他于2年前因非典型肺类癌（T2a，N0，M0；ⅠB期）接受了右上肺叶切除术。正电子发射断层扫描-计算机断层扫描未显示肝外肿瘤表现。肿瘤位于第2、3、5/8段及右肝静脉引流区。我们计划通过两期肝切除术完整切除转移灶。第一期包括同期左外叶切除术、第5/8段部分肝切除术及门静脉后段分支栓塞。第二期为右肝静脉引流区切除术，在第一次手术后21天进行。组织病理学诊断为非典型肺类癌肝转移。术后出现胆漏，通过内镜逆行胆管引流和经皮胆漏引流进行治疗。术后随访24个月无肿瘤复发。
两期肝切除术可能是治疗非典型肺类癌双叶多发肝转移的一种选择。
我们通过两期肝切除术联合门静脉后段分支栓塞成功治疗了1例非典型肺类癌多发肝转移患者。
