J Korean Surg Soc.  2012 Feb;82(2):128-133. 10.4174/jkss.2012.82.2.128.

More than 7-year survival of a patient following repeat hepatectomy for total 20 colon cancer liver metastases

• Yang KH
• Ryu JH
• Moon KM
• Chu CW

• KMID: 2212213
• DOI: http://doi.org/10.4174/jkss.2012.82.2.128

Abstract

A 54-year-old man was transferred with sigmoid colon cancer combined with multiple bilobar liver metastases. Nine metastases were in the left lobe and 5 metastases were in the right lobe. After low anterior resection, all 9 lesions in the left lobe were completely removed by wedge resections. Because the remnant liver volume after multiple wedge resection of the left lobe was not sufficient to perform a right hepatectomy simultaneously, we planned a two-stage hepatectomy. Right portal vein embolization was performed one week after the first liver operation. A right hepatectomy was safely performed 22 days after the first hepatectomy. A recurrent mass developed in the segment III 18 months after the right hepatectomy. Radiofrequency ablation (RFA) was performed to remove that lesion. Five other metastases developed 18 months after RFA whereby multiple wedge resections were performed. The patient has survived for more than 7 years after the first liver operation.

Keyword

Colorectal neoplasms; Neoplasm metastasis; Liver; Hepatectomy

MeSH Terms

Colon
Colonic Neoplasms
Colorectal Neoplasms
Hepatectomy
Humans
Liver
Middle Aged
Neoplasm Metastasis
Portal Vein
Sigmoid Neoplasms

Figure

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  Fig. 1 Initial abdominal ultrasonography and computed tomography. Four lesions in left lobe and 5 lesions in right lobe were found (white arrow, metastases in left lobe; black arrow, metastases in right lobe).

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  Fig. 2 (A) Abdominal computed tomography (CT) that was checked the day after first hepatectomy. Expected remnant liver volume was measured to be 29.5%. (B) Abdominal CT that was performed three weeks after first hepatectomy. Expected remnant liver volume increased to 35.8%. (C) Hypertrophied left lobe found in second hepatectomy. (D) Right hepatectomy was performed according to anatomical demarcation line.

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  Fig. 3 (A) Abdominal computed tomography (CT) taken at 15 months after second-stage hepatectomy showed no recurrent lesion. (B) Magnetic resonance image taken at 18 months after second-stage hepatectomy. Single recurrent mass (arrow) developed in remaining liver. (C) Abdominal CT checked after radiofrequency ablation (arrow, post-radiofrequency ablation lesion). (D) Abdominal CT taken at 14 months after radiofrequency ablation showed no other recurrent lesion (arrow, post-radiofrequency ablation lesion).

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  Fig. 4 Abdominal computed tomography and magnetic resonance image taken at 36 months after second-stage hepatectomy (arrows, multiple recurrent lesions).

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  Fig. 5 Abdominal computed tomography taken at 7 years after initial hepatectomy. No recurrent lesion was found.

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