内容紹介
A Case of a Long-Term Survivor Who Underwent Surgical Intervention for Hepatocellular Carcinoma Combined with Tumor Thrombus in the Main Trunk of the Portal Vein
Summary
We reported a patient survived more than 7 years after undergoing hepatectomy accompanied by tumor thrombectomy in the main trunk of the portal vein after preoperative hepatic arterial chemotherapy for hepatocellular carcinoma combined with tumor thrombus in the main portal vein. A 58-year-old man underwent hepatic arterial infusion therapy with 5-fluorouracil(5-FU)plus cisplatin(CDDP)for 6 weeks for a solitary 7 cm nodule of hepatocellular carcinoma on the liver(S6)with tumor thrombus in the main portal vein. Although hepatic arterial infusion therapy was effective and the tumor shrank markedly, the tumor thrombus of the main portal vein still existed and the existence of portal hypertension was predicted from lower platelet values. Therefore, we performed hepatectomy accompanied by tumor thrombectomy in the main portal vein. Four months after surgery, staining of a single tumor was observed in the residual liver by contrast computed tomography(CT)and Lipiodol-TAI was performed. There was no recurrence of cancer for about 4 years, when a single recurrent lesion was found in the liver caudate lobe and a single lung metastatic lesion was also found in the left lower lobe section. We performed hepatectomy of the caudate lobe, and furthermore, we performed the left basilar segmentectomy. After these operations, the patient remained cancer free and died suddenly of another disease 7 years after the first treatment for the hepatoma.
要旨
門脈本幹腫瘍栓(Vp4)合併肝細胞癌に対して,術前肝動注化学療法後に肝切除・門脈腫瘍栓摘除術を施行し,7年以上生存した症例を経験した。症例は58歳,男性。門脈本幹腫瘍栓を伴う肝S6を中心とする7 cm大の単発の肝細胞癌に対し,5-fluorouracil(5-FU)+cisplatin(CDDP)による肝動注療法を6週間施行した。肝動注療法は奏効し腫瘍は著明に縮小したが,門脈本幹腫瘍栓は依然として存在し,血小板値は6.7×10 4/mm3と低値であったため,肝切除・門脈腫瘍栓摘除術を施行した。術後4か月の造影CT検査で残肝に単発の腫瘍染像を認め,Lipiodol-TAIを施行した。その後4年間癌の再燃なく経過したが,肝尾状葉に単発の再発巣かつ左肺底区に単発の肺転移巣を認め,肝尾状葉部分切除さらに左肺底区域切除を施行し,その後はcancer freeで経過していた。治療開始から7年後に他病死した。
目次
Summary
We reported a patient survived more than 7 years after undergoing hepatectomy accompanied by tumor thrombectomy in the main trunk of the portal vein after preoperative hepatic arterial chemotherapy for hepatocellular carcinoma combined with tumor thrombus in the main portal vein. A 58-year-old man underwent hepatic arterial infusion therapy with 5-fluorouracil(5-FU)plus cisplatin(CDDP)for 6 weeks for a solitary 7 cm nodule of hepatocellular carcinoma on the liver(S6)with tumor thrombus in the main portal vein. Although hepatic arterial infusion therapy was effective and the tumor shrank markedly, the tumor thrombus of the main portal vein still existed and the existence of portal hypertension was predicted from lower platelet values. Therefore, we performed hepatectomy accompanied by tumor thrombectomy in the main portal vein. Four months after surgery, staining of a single tumor was observed in the residual liver by contrast computed tomography(CT)and Lipiodol-TAI was performed. There was no recurrence of cancer for about 4 years, when a single recurrent lesion was found in the liver caudate lobe and a single lung metastatic lesion was also found in the left lower lobe section. We performed hepatectomy of the caudate lobe, and furthermore, we performed the left basilar segmentectomy. After these operations, the patient remained cancer free and died suddenly of another disease 7 years after the first treatment for the hepatoma.
要旨
門脈本幹腫瘍栓(Vp4)合併肝細胞癌に対して,術前肝動注化学療法後に肝切除・門脈腫瘍栓摘除術を施行し,7年以上生存した症例を経験した。症例は58歳,男性。門脈本幹腫瘍栓を伴う肝S6を中心とする7 cm大の単発の肝細胞癌に対し,5-fluorouracil(5-FU)+cisplatin(CDDP)による肝動注療法を6週間施行した。肝動注療法は奏効し腫瘍は著明に縮小したが,門脈本幹腫瘍栓は依然として存在し,血小板値は6.7×10 4/mm3と低値であったため,肝切除・門脈腫瘍栓摘除術を施行した。術後4か月の造影CT検査で残肝に単発の腫瘍染像を認め,Lipiodol-TAIを施行した。その後4年間癌の再燃なく経過したが,肝尾状葉に単発の再発巣かつ左肺底区に単発の肺転移巣を認め,肝尾状葉部分切除さらに左肺底区域切除を施行し,その後はcancer freeで経過していた。治療開始から7年後に他病死した。