Nakagawa Masataka, Sumitani Daisuke, Matsubara Keiso, Ota Hiroshi, Yano Masatsugu
Department of Surgery, JR Hiroshima Hospital, 3-1-36 Hutabanosato, Higashi-ku, Hiroshima 732-0057, Japan.
Department of Surgery, JR Hiroshima Hospital, 3-1-36 Hutabanosato, Higashi-ku, Hiroshima 732-0057, Japan.
Int J Surg Case Rep. 2024 Dec;125:110600. doi: 10.1016/j.ijscr.2024.110600. Epub 2024 Nov 12.
Metastatic liver tumors result from distant metastasis of a primary tumor. While chemotherapy is the treatment of choice, liver resection is aggressively performed for metastatic liver cancer derived from colorectal cancer. However, during chemotherapy, some disappearing liver metastases (DLMs) can be undetectable on computed tomography (CT), and surgical treatment remains challenging.
A 48-year-old woman with abdominal pain and constipation was diagnosed with multiple liver metastases of colorectal cancer (CRLM) origin after a thorough examination involving CT and ethoxybenzyl-magnetic resonance imaging. Thirteen simultaneous CRLM were observed (largest metastasis diameter, 37 mm). Resection of the primary tumor (laparoscopy-assisted left colon resection + D3 dissection) was performed. Following eight courses of chemotherapy with mFOLFOX6 + panitumumab, only two CRLM and 11 DLMs were detectable on CT. With no new lesions identified, the patient underwent anterior segment resection and segment 3 and segment 7 partial hepatectomies. Contrast-enhanced intraoperative ultrasonography was performed, and all detectable lesions were resected. However, pathology results showed three CRLM in the anterior segment and no tumor cells in the segment 3 and segment 7 specimens. Postoperatively, the patient received eight courses of adjuvant chemotherapy with capecitabine and oxaliplatin (with capecitabine as a single agent beginning mid-course). The patient is currently alive and recurrence-free 3.5 years post-hepatic resection.
The utility of EOB-MRI in the detection of DLMs has been demonstrated. The incidence of residual disease and subsequent early recurrence at sites diagnosed as DLMs on CT is reported to be approximately 80 %. Although aggressive resection of resectable DLMs is desirable to the extent that residual liver function can be preserved, recurrence is frequent and long-term careful follow-up is considered important.
Our patient, with multiple CRLM, responded to chemotherapy and underwent conversion surgery following resection of the primary tumor. Surgeons should consider possible surgical resection and DLM management when selecting the primary treatment.
转移性肝肿瘤源于原发肿瘤的远处转移。虽然化疗是首选治疗方法，但对于源自结直肠癌的转移性肝癌，积极进行肝切除术。然而，在化疗期间，一些消失的肝转移灶（DLM）在计算机断层扫描（CT）上可能无法检测到，手术治疗仍然具有挑战性。
一名48岁腹痛和便秘的女性，在经过包括CT和乙氧基苄基磁共振成像的全面检查后，被诊断为源自结直肠癌（CRLM）的多发肝转移。观察到13个同时存在的CRLM（最大转移直径37毫米）。进行了原发肿瘤切除（腹腔镜辅助左半结肠切除+D3淋巴结清扫）。在接受8个疗程的mFOLFOX6+帕尼单抗化疗后，CT上仅可检测到2个CRLM和11个DLM。由于未发现新病变，患者接受了前段切除以及第3段和第7段部分肝切除术。进行了术中对比增强超声检查，并切除了所有可检测到的病变。然而，病理结果显示前段有3个CRLM，第3段和第7段标本中无肿瘤细胞。术后，患者接受了8个疗程的卡培他滨和奥沙利铂辅助化疗（从疗程中期开始卡培他滨单药治疗）。患者目前在肝切除术后3.5年存活且无复发。
已证明EOB-MRI在检测DLM方面的效用。据报道，在CT上诊断为DLM的部位，残留疾病和随后早期复发的发生率约为80%。尽管在能够保留残余肝功能的程度上，积极切除可切除的DLM是可取的，但复发频繁，长期仔细随访被认为很重要。
我们的患者患有多发CRLM，对化疗有反应，并在原发肿瘤切除后接受了转化手术。外科医生在选择初始治疗时应考虑可能的手术切除和DLM管理。
