Zhang Shi-Ran, Ma Yu, Zhou Bo, Li Guang-Yao, Chen Ping, Chen Geng
Department of Hepatobiliary Surgery, Daping Hospital, Army Medical University, Chongqing, China.
Front Surg. 2023 Apr 27;10:1115181. doi: 10.3389/fsurg.2023.1115181. eCollection 2023.
Liver resection (LR) is considered the mainstay treatment for eligible patients with hepatocellular carcinoma (HCC) and provides a 5-year overall survival (OS) of 60%-80%. However, the recurrence rate within five years after LR remains high, ranging from 40% to 70%. Recurrence in gallbladder after liver resection is extremely rare. Here, we present a case of isolated recurrence in gallbladder after curative resection of HCC and review the relevant literature. No similar cases have been reported before.
A 55-year-old male patient was diagnosed with HCC in 2009 and subsequently underwent a right posterior sectionectomy of the liver. In 2015, the patient underwent liver tumor radiofrequency ablation and three transarterial chemoembolization (TACE) procedures in succession for HCC recurrence. In 2019, a gallbladder lesion was detected by computed tomography (CT) without perceivable intrahepatic focus. We performed an resection of the gallbladder and hepatic segment IVb. The pathological biopsy suggested that the gallbladder tumor was moderately differentiated HCC. The patient survived more than 3 years in good condition, and there were no signs of tumor recurrence.
In patients with isolated gallbladder metastasis, if the lesion can be resected without remnants, surgery should be the preferred option. Both postoperative molecularly targeted drugs and immunotherapy are expected to improve the long-term prognosis.
肝切除术（LR）被认为是符合条件的肝细胞癌（HCC）患者的主要治疗方法，其5年总生存率（OS）为60%-80%。然而，LR术后五年内的复发率仍然很高，在40%至70%之间。肝切除术后胆囊复发极为罕见。在此，我们报告一例HCC根治性切除术后胆囊孤立性复发的病例，并回顾相关文献。此前未见类似病例报道。
一名55岁男性患者于2009年被诊断为HCC，随后接受了肝脏右后叶切除术。2015年，该患者因HCC复发先后接受了肝脏肿瘤射频消融和三次经动脉化疗栓塞（TACE）治疗。2019年，通过计算机断层扫描（CT）检测到胆囊病变，未发现肝内病灶。我们进行了胆囊及肝IVb段切除术。病理活检提示胆囊肿瘤为中分化HCC。患者状况良好地存活了3年多，且无肿瘤复发迹象。
对于孤立性胆囊转移患者，如果病变能够完整切除，手术应作为首选方案。术后分子靶向药物和免疫治疗均有望改善长期预后。
