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Case Reports
. 2019 Jun 13;17(1):99.
doi: 10.1186/s12957-019-1646-0.

Hepatectomy for metachronous colorectal liver metastases following complete cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for peritoneal metastases: a report of three cases

Kyoji Ito  1 , Nobuyuki Takemura  1 , Fuyuki Inagaki  1 , Fuminori Mihara  1 , Toshiaki Kurokawa  1 , Yoshimasa Gohda  2 , Tomomichi Kiyomatsu  2 , Hideaki Yano  2 , Norihiro Kokudo  3
Affiliations
Case Reports

Hepatectomy for metachronous colorectal liver metastases following complete cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for peritoneal metastases: a report of three cases

Kyoji Ito et al. World J Surg Oncol. .

Abstract

Background: Cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) for peritoneal metastasis (PM) from colorectal cancer (CRC) has been reported to substantially improve the prognosis and the quality of life of patients in comparison to systemic chemotherapy or palliative approaches. This study aimed to demonstrate the safety and feasibility of hepatectomy for metachronous liver metastases from CRC following CRS and HIPEC for PM on the basis of three case reports.

Case presentation: We describe three cases involving patients who underwent hepatectomy for metachronous liver metastases from CRC after CRS and HIPEC for PM. All patients underwent CRS and HIPEC after primary tumor resection, and hepatectomy was performed for the metachronous liver metastases after CRS and HIPEC. The hepatectomy procedures for cases 1, 2, and 3 were left hemihepatectomy and partial resection of S5, posterior sectionectomy, and left-lateral sectionectomy and partial resection of S5 and S8, respectively. Although adhesion of surrounding organs to the liver surface was observed on a broad level, dissections and hepatectomy could be performed safely. No recurrence was detected in cases 1 and 2 after hepatectomy. In case 3, liver metastases were detected from the time of the initial diagnosis of the primary tumor, and complete remission was achieved once with systemic chemotherapy. Although we performed hepatectomy for the recurrence of liver metastases after complete remission, early re-recurrence was observed after hepatectomy.

Conclusions: Hepatectomy for metachronous liver metastases after CRS and HIPEC for PM could be a multi-modality treatment option for CRC recurrence.

Keywords: Colorectal cancer; Cytoreductive surgery; Hepatectomy; Hyperthermic intraperitoneal chemotherapy; Liver metastases; Multi-modality treatment; Peritoneal metastases.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Representative images of the CRS procedure around the liver. a The peritoneum of the bilateral diaphragm was stripped, and the liver surface serosa was ablated. b Peritonectomy of the hepatoduodenal ligament and retroperitoneum around the liver was performed. The lesser omentum was resected. HDL, hepatoduodenal ligament; IVC, inferior vena cava; CRS, cytoreductive surgery
Fig. 2
Fig. 2
The locations of liver metastases on MRI in the hepatocyte phase. The locations of the tumors are shown with the arrowhead. a Case 1. Liver metastases were detected in segments 2 and 5. b Case 2. Liver metastases were detected in segment 6. c Case 3. Liver metastases were detected in segments 2, 3, 5, and 8. MRI, magnetic resonance imaging
Fig. 3
Fig. 3
Intraoperative photograph of case 1, where left hemihepatectomy was performed. a Adhesion of the liver surface was broad. b Dissection of the hepatoduodenal ligament. The left portal vein and left hepatic artery were taped. The middle hepatic artery was cut (arrowhead). c Transection surface of the liver. LHA, left hepatic artery; LPV, left portal vein
Fig. 4
Fig. 4
Summary of the clinical courses of the three cases. CRS, cytoreductive surgery; HIPEC, hyperthermic intraperitoneal chemotherapy; PM, peritoneal metastases
See this image and copyright information in PMC

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