Hirata Wataru, Itatani Yoshiro, Hida Koya, Okamura Ryosuke, Hoshino Nobuaki, Maekawa Hisatsugu, Nishigori Tatsuto, Hisamori Shigeo, Tsunoda Shigeru, Obama Kazutaka
Department of Surgery, Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawaharacho, Sakyo-ku, Kyoto, 606-8507 Japan.
Int Cancer Conf J. 2024 Jun 5;13(4):336-341. doi: 10.1007/s13691-024-00688-0. eCollection 2024 Oct.
The prognosis for patients with hepatocellular carcinoma (HCC) with extrahepatic metastasis remains poor. In recent years, the combination therapy of atezolizumab plus bevacizumab (ATZ/BEV) has demonstrated remarkable antitumor efficacy against HCC. Conversion surgery following chemotherapy emerges as a promising strategy for initially unresectable HCC. A 74-year-old man was referred to our department with disseminated HCC in the rectovesical pouch. He underwent hepatic subsegmental resection for primary HCC with abdominal wall invasion on the background of chronic hepatitis B 7 years ago. Intrahepatic recurrence was emerged 5 and 2 years ago, which was successfully managed with transarterial chemoembolization and radiofrequency ablation, respectively. Subsequently, 4 cm peritoneal dissemination appeared in the rectovesical pouch, invading the rectum, right pelvic neural plexus, and right seminal vesicle. ATZ/BEV therapy was initiated, but bevacizumab had to be discontinued due to fistula formation between the rectum and the tumor after two courses, and atezolizumab monotherapy was continued. After 1 year of ATZ/BEV combined therapy followed by atezolizumab monotherapy, the disseminated tumor, though still visible, exhibited a significant reduction, with no new intra- or extrahepatic lesions. To confirm the absence of other disseminated lesions, a diagnostic laparoscopy was performed. Subsequently, robot-assisted extended rectal anterior resection with the right seminal vesicle and right pelvic neural plexus, and permanent colostomy (Hartmann's procedure) were performed. Histopathological examination revealed disseminated HCC with a 4 mm resection margin to achieve R0 resection. We present a case of disseminated HCC successfully undergoing curative surgery through robot-assisted extended rectal anterior resection following ATZ/BEV combined therapy.
The online version contains supplementary material available at 10.1007/s13691-024-00688-0.
肝细胞癌（HCC）伴肝外转移患者的预后仍然很差。近年来，阿替利珠单抗联合贝伐珠单抗（ATZ/BEV）的联合疗法已显示出对HCC具有显著的抗肿瘤疗效。化疗后进行转化手术成为最初不可切除HCC的一种有前景的策略。一名74岁男性因直肠膀胱陷凹播散性HCC转诊至我科。7年前，他因慢性乙型肝炎背景下原发性HCC侵犯腹壁而接受了肝亚段切除术。5年前和2年前分别出现肝内复发，分别成功通过经动脉化疗栓塞术和射频消融术进行了治疗。随后，直肠膀胱陷凹出现4 cm腹膜播散，侵犯直肠、右侧盆腔神经丛和右侧精囊。开始ATZ/BEV治疗，但在两个疗程后，由于直肠与肿瘤之间形成瘘管，不得不停用贝伐珠单抗，继续使用阿替利珠单抗单药治疗。在进行1年的ATZ/BEV联合治疗后再进行阿替利珠单抗单药治疗后，播散性肿瘤虽然仍可见，但显著缩小，无新的肝内或肝外病变。为确认无其他播散性病变，进行了诊断性腹腔镜检查。随后，进行了机器人辅助扩大直肠前切除术，切除右侧精囊和右侧盆腔神经丛，并进行了永久性结肠造口术（哈特曼手术）。组织病理学检查显示为播散性HCC，切缘4 mm，实现了R0切除。我们报告一例播散性HCC患者，在ATZ/BEV联合治疗后通过机器人辅助扩大直肠前切除术成功接受了根治性手术。
在线版本包含可在10.1007/s13691-024-00688-0获取的补充材料。
