Kobayahshi Kei, Nojiri Kazunori, Suwa Hirokazu, Yoshida Kenichi, Masui Hidenobu
Department of Gastrointestinal Surgery, Yokosuka Kyosai Hospital, Yokosuka, JPN.
Cureus. 2024 Sep 20;16(9):e69776. doi: 10.7759/cureus.69776. eCollection 2024 Sep.
Small bowel adenocarcinoma (SBA) is a relatively rare disease that is difficult to detect in the early stages; therefore, it often has a poor prognosis. We present a rare case of SBA and multiple liver metastases in a patient who underwent curative resection combined with neoadjuvant chemotherapy (NAC). A 70-year-old woman presented to the emergency department complaining of abdominal pain and bloating. She was diagnosed with bowel obstruction due to a primary jejunal tumor and was admitted to the hospital. After further imaging and histopathological examination, the patient was diagnosed with primary jejunal adenocarcinoma with multiple liver metastases, all of which were considered resectable. Since she had developed bowel obstruction due to the primary tumor, jejunal resection with draining lymph node removal was initially performed. The remaining multiple liver metastases were treated with four courses of capecitabine and oxaliplatin (CAPEOX) with bevacizumab as NAC, followed by hepatectomy. After NAC, the patient underwent radical liver resection. Based on a pathological examination, the five liver tumors were all diagnosed as liver metastases from jejunal adenocarcinoma. Six months after the liver resection, a single recurrence was observed in segment V of the liver. Therefore, four courses of CAPEOX with bevacizumab were administered again as NAC, and liver resection was performed again. At the time of writing this report, she has survived for more than four years after the first surgery, with no apparent recurrence. This is a rare case of a patient who underwent radical resection of SBA with multiple liver metastases following CAPEOX and bevacizumab as NAC.
小肠腺癌（SBA）是一种相对罕见的疾病，早期难以检测；因此，其预后通常较差。我们报告一例罕见的SBA合并多发肝转移患者，该患者接受了根治性切除联合新辅助化疗（NAC）。一名70岁女性因腹痛和腹胀就诊于急诊科。她被诊断为原发性空肠肿瘤导致的肠梗阻，并入院治疗。经过进一步的影像学和组织病理学检查，患者被诊断为原发性空肠腺癌伴多发肝转移，所有转移灶均被认为可切除。由于她因原发性肿瘤出现了肠梗阻，最初进行了空肠切除并清扫引流淋巴结。其余多发肝转移灶采用卡培他滨和奥沙利铂（CAPEOX）联合贝伐单抗进行四个疗程的NAC治疗，随后进行肝切除术。NAC治疗后，患者接受了根治性肝切除术。根据病理检查，五个肝肿瘤均被诊断为空肠腺癌的肝转移灶。肝切除术后六个月，在肝Ⅴ段观察到单发复发。因此，再次给予四个疗程的CAPEOX联合贝伐单抗作为NAC治疗，并再次进行肝切除术。在撰写本报告时，她在首次手术后已存活四年多，无明显复发。这是一例罕见的患者，在接受CAPEOX联合贝伐单抗作为NAC治疗后，成功根治性切除了伴多发肝转移的SBA。
