Ohya Yuki, Hayashida Shintaro, Tsuji Akira, Kuramoto Kunitaka, Shibata Hidekatsu, Setoyama Hiroko, Hayashi Hironori, Kuriwaki Kazumi, Sasaki Masato, Iizaka Masayoshi, Nakahara Osamu, Inomata Yukihiro
Department of Surgery, Kumamoto Rosai Hospital, 1670 Takehara-machi, Yatsushiro, Kumamoto, 866-8533, Japan.
Department of Gastroenterology and Hepatology, Kumamoto Rosai Hospital, 1670 Takehara-machi, Yatsushiro, Kumamoto, 866-8533, Japan.
Surg Case Rep. 2020 Dec 10;6(1):318. doi: 10.1186/s40792-020-01078-3.
Lenvatinib is a novel tyrosine kinase inhibitor that exhibits an antitumor effect on hepatocellular carcinoma (HCC). An established strategy that involves surgery and usage of lenvatinib for advanced HCC remains elusive.
A 58-year-old male patient with advanced HCC and untreated hepatitis B was referred to our hospital. The tumor at the right lobe was 10 cm in diameter with right portal vein thrombus. Because of the possible lung metastasis and concern about the remaining hepatic function after extended right hepatectomy, lenvatinib was initiated before surgery. After the confirmation of a sharp decrease of tumor markers during the 3-week lenvatinib therapy, only a right portal vein transection was done leaving the enlargement of the left lobe for improved post-hepatectomy liver function while lenvatinib therapy was continued. The laparotomy revealed that the tumor was invading the right diaphragm. After 7 weeks of lenvatinib administration after right portal vein transection, an extended right hepatectomy with resection of the tumor-invaded diaphragm was successfully done. The lung nodules that were suspected as metastases had disappeared. The patient has been doing well without any sign of recurrence for 1 year.
The strategy involving the induction of lenvatinib to conversion hepatectomy including the portal vein transection was effective for advanced HCC.
乐伐替尼是一种新型酪氨酸激酶抑制剂，对肝细胞癌（HCC）具有抗肿瘤作用。一种涉及手术和使用乐伐替尼治疗晚期HCC的既定策略仍不明确。
一名58岁患有晚期HCC且未治疗的乙型肝炎男性患者被转诊至我院。右叶肿瘤直径为10厘米，伴有右门静脉血栓形成。由于可能存在肺转移以及担心扩大右肝切除术后的剩余肝功能，在手术前开始使用乐伐替尼。在3周的乐伐替尼治疗期间确认肿瘤标志物急剧下降后，仅进行了右门静脉横断术，保留左叶增大以改善肝切除术后的肝功能，同时继续乐伐替尼治疗。剖腹手术显示肿瘤侵犯右膈肌。在右门静脉横断术后给予乐伐替尼7周后，成功进行了扩大右肝切除术并切除了受肿瘤侵犯的膈肌。疑似转移的肺结节已消失。该患者1年来情况良好，无任何复发迹象。
包括门静脉横断术在内的乐伐替尼诱导转化肝切除术策略对晚期HCC有效。
