Endo Yutaka, Shimazu Motohide, Sakuragawa Tadayuki, Uchi Yusuke, Edanami Motonori, Sunamura Ken, Ozawa Soji, Chiba Naokazu, Kawachi Shigeyuki
Department of Surgery, Tama Kyuryo Hospital, Tokyo 1940297, Japan.
Department of Digestive and Transplantation Surgery, Tokyo Medical University Hachioji Medical Center, Tokyo 1930998, Japan.
World J Gastrointest Surg. 2022 Mar 27;14(3):260-267. doi: 10.4240/wjgs.v14.i3.260.
Hepatocellular carcinoma (HCC) with massive portal vein tumor thrombosis (PVTT) and distant metastasis is considered unresectable. However, due to recent developments in systemic chemotherapy, successful cases of conversion therapy for unresectable diseases have been reported. Herein, we report a successful multidisciplinary approach for treatment of multi-visceral recurrence with sequential multikinase inhibitor and laparoscopic surgery.
A 63-year-old woman with chronic hepatitis B virus infection was diagnosed with HCC. Subsequently, she underwent two rounds of laparoscopic partial hepatectomy, laparoscopic left adrenalectomy, and transcatheter arterial chemoembolization plus sorafenib for recurrence. Four years after initial hepatectomy, she presented with a 43-mm mass in the spleen and tumor thrombus involving the main portal vein trunk with ascites. Her liver function was Child-Pugh B (8), and protein induced by vitamin K absence or antagonist II (PIVKA II) levels were elevated up to 46.291 mAU/mL. Since initial treatment with regorafenib for three months was unsuccessful, the patient was administered lenvatinib. Ten months post-treatment, there was no contrast enhancement of PVTT or splenic metastasis. Chemotherapy was discontinued due to severe diarrhea. Afterward, splenic metastasis became viable, and PIVKA II increased. Therefore, hand-assisted laparoscopic splenectomy was performed. She experienced no clinical recurrence 14 mo after resection.
Conversion surgery after successful multikinase inhibitor treatment might be considered an effective treatment option for advanced HCC.
伴有大量门静脉癌栓（PVTT）和远处转移的肝细胞癌（HCC）被认为不可切除。然而，由于全身化疗的最新进展，已报道了不可切除疾病转化治疗的成功案例。在此，我们报告了一种采用序贯多激酶抑制剂和腹腔镜手术治疗多脏器复发的成功多学科方法。
一名63岁慢性乙型肝炎病毒感染女性被诊断为HCC。随后，她接受了两轮腹腔镜肝部分切除术、腹腔镜左肾上腺切除术以及经动脉化疗栓塞联合索拉非尼治疗复发。初次肝切除术后四年，她出现脾脏43毫米肿块以及累及门静脉主干的肿瘤血栓并伴有腹水。她的肝功能为Child-Pugh B级（8分），维生素K缺乏或拮抗剂II诱导蛋白（PIVKA II）水平升高至46.291 mAU/mL。由于最初使用瑞戈非尼治疗三个月未成功，该患者改用乐伐替尼。治疗十个月后，PVTT或脾脏转移灶无强化。因严重腹泻停止化疗。此后，脾脏转移灶再次出现活性，PIVKA II升高。因此，进行了手辅助腹腔镜脾切除术。切除术后14个月她未出现临床复发。
多激酶抑制剂治疗成功后的转化手术可能被认为是晚期HCC的一种有效治疗选择。
