Shidahara Hidetoshi, Abe Tomoyuki, Oshita Akihiko, Sumi Yusuke, Okuda Hiroshi, Kurayoshi Manabu, Yonehara Shuji, Kobayashi Tsuyoshi, Ohdan Hideki, Noriyuki Toshio, Nakahara Masahiro
Department of Surgery, Onomichi General Hospital, Onomichi, Hiroshima, Japan.
Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
Surg Case Rep. 2022 Aug 1;8(1):144. doi: 10.1186/s40792-022-01503-9.
Delayed onset of colorectal liver metastasis (CRLM) > 5 years after primary colorectal surgery is rare. Herein, we report a case of delayed-onset CRLM that occurred 10 years after primary surgery, for which laparoscopic hepatectomy was performed.
A 68-year-old man was admitted to the hospital. His medical history revealed double colon cancer detected 10 years ago, for which laparoscopic colectomy was performed. The pathological tumor-node-metastasis stages were stages I and II. Thereafter, oral floor cancer occurred 7 years after the primary surgery and was curatively resected. The annual follow-up with positron emission tomography-computed tomography (CT) identified a tumor at segment 7/8 (S7/8) of the liver with an abnormal accumulation of fluorodeoxyglucose. Dynamic CT showed a 23-mm tumor, with ring enhancement in the early phase. Magnetic resonance imaging with gadolinium-ethoxybenzyl-diethylenetriamine penta-acetic acid demonstrated that the tumor had high intensity in T2 weighted sequences and low intensity in the hepatobiliary phase. With a preoperative diagnosis of intrahepatic cholangiocarcinoma or delayed liver metastasis, laparoscopic S7/8 partial resection was performed. The operative time was 324 min, and the intraoperative bleeding volume was 35 mL. The patient was discharged on day 15 without any postoperative complications. Upon histopathological examination, the final diagnosis was CRLM. The patient has survived for 1 year without any recurrence.
It is important to pay attention to the occurrence of delayed-metachronous CRLM.
结直肠癌肝转移（CRLM）在原发性结直肠癌手术后5年以上出现较为罕见。在此，我们报告一例原发性手术后10年发生的延迟性CRLM病例，并对其实施了腹腔镜肝切除术。
一名68岁男性入院。他的病史显示10年前检测出患有双结肠癌，接受了腹腔镜结肠切除术。病理肿瘤-淋巴结-转移分期为I期和II期。此后，在原发性手术后7年发生了口腔底癌，并进行了根治性切除。每年通过正电子发射断层扫描-计算机断层扫描（CT）进行随访，发现肝脏第7/8段（S7/8）有一个肿瘤，氟脱氧葡萄糖异常聚集。动态CT显示一个23毫米的肿瘤，早期呈环形强化。使用钆乙氧基苄基二乙三胺五乙酸进行磁共振成像显示，该肿瘤在T2加权序列中呈高信号，在肝胆期呈低信号。术前诊断为肝内胆管癌或延迟性肝转移，遂进行了腹腔镜S7/8部分切除术。手术时间为324分钟，术中出血量为35毫升。患者于第15天出院，无任何术后并发症。经组织病理学检查，最终诊断为CRLM。患者已存活1年，无任何复发。
重视延迟性异时性CRLM的发生很重要。
