Department of Gastroenterological Surgery, Okayama University Hospital, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan.
J Med Case Rep. 2022 Jun 6;16(1):222. doi: 10.1186/s13256-022-03440-5.
The optimal management for peritoneal dissemination in patients with hepatocellular carcinoma remains unclear. Although several reports have described the usefulness of surgical resection, the indications should be carefully considered. Herein, we report the case of a patient with hepatocellular carcinoma with peritoneal recurrence who underwent surgical resection using an indocyanine green fluorescence navigation system and achieved favorable disease control.
A 45-year-old Asian woman underwent left hemihepatectomy for a ruptured hepatocellular carcinoma. Seventeen months after the initial surgery, a single nodule near the cut surface of the liver was detected on computed tomography, along with elevation of tumor markers. The patient was diagnosed with peritoneal metastasis and underwent a surgical resection. Twelve months later, a single nodule on the dorsal side of the right hepatic lobe was detected on computed tomography, and we performed surgical resection. Indocyanine green (0.5 mg/kg) was intravenously administered 3 days before surgery, and the indocyanine green fluorescence imaging system revealed clear green fluorescence in the tumor, which helped us perform complete resection. Indocyanine green fluorescence enabled the detection of additional lesions that could not be identified by preoperative imaging, especially in the second metastasectomy. There was no further recurrence at 3 months postoperatively.
When considering surgical intervention for peritoneal recurrence in patients with hepatocellular carcinoma, complete resection is mandatory. Given that disseminated nodules are sometimes too small to be detected by preoperative imaging studies, intraoperative indocyanine green fluorescence may be an essential tool for determining the indications for surgical resection.
肝细胞癌患者腹膜转移的最佳治疗方法仍不明确。尽管有几项研究报道了手术切除的有效性，但手术适应证仍需慎重考虑。本文报告了 1 例应用吲哚菁绿荧光导航系统行手术切除治疗并获得良好疾病控制的肝细胞癌伴腹膜复发患者。
1 名 45 岁亚洲女性因破裂的肝细胞癌行左半肝切除术。初次手术后 17 个月，患者 CT 发现肝切缘附近单发结节，肿瘤标志物升高。诊断为腹膜转移，行手术切除。12 个月后，CT 发现右肝背侧单发结节，再次行手术切除。手术前 3 天，患者静脉给予吲哚菁绿（0.5mg/kg），吲哚菁绿荧光成像系统显示肿瘤呈明显绿色荧光，有助于我们行完全性切除。吲哚菁绿荧光能检测到术前影像学无法识别的其他病灶，尤其是在第二次转移灶切除术中。术后 3 个月无复发。
对于肝细胞癌腹膜复发患者，当考虑手术干预时，必须行完全性切除。由于播散性结节有时太小而无法通过术前影像学检查发现，术中吲哚菁绿荧光可能是决定手术切除适应证的重要工具。
