内容紹介
A Case of Multiple Liver Metastases from Colon Cancer Treated with Complete Resection via Two-Stage Hepatectomy after Regeneration of the Liver
Summary
A 55-year-old woman underwent low anterior resection for sigmoid colon cancer with multiple bilobar metastases. She then received 23 courses of Leucovorin, fluorouracil, and oxaliplatin(mFOLFOX)plus bevacizumab and 13 courses of Leucovorin, fluorouracil, and irinotecan(FOLFIRI)plus bevacizumab as down staging chemotherapy. A two-stage hepatectomy was planned to avoid the risk of hepatic failure due to radial resection of bilobar metastases. Therefore, a right lobectomy was performed, and curative resection was achieved 54 days after the first hepatectomy. Two-stage hepatectomy as well as a combination of induction chemotherapy and portal vein embolization may have contributed to the improved prognosis of the initially unresectable multiple bilobar liver metastases.
要旨
症例は55歳,女性。S状結腸癌,多発肝転移(H3)に対して低位前方切除術を施行。その後,down stageを目的にbevacizumab+FOLFOX 23コース,その後bevacizumab+FOLFIRI 13コース施行。十分なdown stageの後,今回の根治的肝切除を施行することとなった。両葉の肝切除を同時に施行すると術後肝不全が懸念されたため二期的手術を検討し,初回に肝右葉切除を施行。十分な残肝の再生を待ち,初回肝切除より第54日目に2回目肝切除を施行し,根治的切除し得た。two-stage hepatectomyの発案により現在,切除不能とされてきたH3症例に対して多くの根治的切除が可能となってきている。今後,two-stage hepatectomyと抗癌剤,分子標的薬,門脈塞栓術の併用,またそのタイミングの検討により,さらなる予後の改善が期待される。
目次
Summary
A 55-year-old woman underwent low anterior resection for sigmoid colon cancer with multiple bilobar metastases. She then received 23 courses of Leucovorin, fluorouracil, and oxaliplatin(mFOLFOX)plus bevacizumab and 13 courses of Leucovorin, fluorouracil, and irinotecan(FOLFIRI)plus bevacizumab as down staging chemotherapy. A two-stage hepatectomy was planned to avoid the risk of hepatic failure due to radial resection of bilobar metastases. Therefore, a right lobectomy was performed, and curative resection was achieved 54 days after the first hepatectomy. Two-stage hepatectomy as well as a combination of induction chemotherapy and portal vein embolization may have contributed to the improved prognosis of the initially unresectable multiple bilobar liver metastases.
要旨
症例は55歳,女性。S状結腸癌,多発肝転移(H3)に対して低位前方切除術を施行。その後,down stageを目的にbevacizumab+FOLFOX 23コース,その後bevacizumab+FOLFIRI 13コース施行。十分なdown stageの後,今回の根治的肝切除を施行することとなった。両葉の肝切除を同時に施行すると術後肝不全が懸念されたため二期的手術を検討し,初回に肝右葉切除を施行。十分な残肝の再生を待ち,初回肝切除より第54日目に2回目肝切除を施行し,根治的切除し得た。two-stage hepatectomyの発案により現在,切除不能とされてきたH3症例に対して多くの根治的切除が可能となってきている。今後,two-stage hepatectomyと抗癌剤,分子標的薬,門脈塞栓術の併用,またそのタイミングの検討により,さらなる予後の改善が期待される。