Case Report
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Feb 14, 2015; 21(6): 1982-1988
Published online Feb 14, 2015. doi: 10.3748/wjg.v21.i6.1982
Successful treatment of conversion chemotherapy for initially unresectable synchronous colorectal liver metastasis
Kenta Baba, Akihiko Oshita, Mohei Kohyama, Satoshi Inoue, Yuta Kuroo, Takuro Yamaguchi, Hiroyuki Nakamura, Yoichi Sugiyama, Tatsuya Tazaki, Masaru Sasaki, Yuji Imamura, Yutaka Daimaru, Hideki Ohdan, Atsushi Nakamitsu
Kenta Baba, Akihiko Oshita, Mohei Kohyama, Satoshi Inoue, Yuta Kuroo, Takuro Yamaguchi, Hiroyuki Nakamura, Yoichi Sugiyama, Tatsuya Tazaki, Masaru Sasaki, Yuji Imamura, Atsushi Nakamitsu, Department of Surgery, JA Hiroshima General Hospital, Hiroshima 738-8503, Japan
Akihiko Oshita, Hideki Ohdan, Department of Gastroenterological and Transplant Surgery, Applied Life Sciences, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima 734-8551, Japan
Yutaka Daimaru, Department of Pathology, JA Hiroshima General Hospital, Hiroshima 738-8503, Japan
Author contributions: The first two authors contributed equally to this work; Oshita A and Kohyama M designed the surgical strategy; Oshita A, Baba K, Kohyama M and Sasaki M performed the operation; Inoue S, Kuroo Y, Yamaguchi T, Nakamura H, Sugiyama Y, Tazaki T, Imamura Y and Nakamitsu A are members of the operating team; Daimaru Y evaluated the historical findings; Baba K and Oshita A wrote the paper; Ohdan H revised the manuscript.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Akihiko Oshita, MD, PhD, Department of Surgery, JA Hiroshima General Hospital, 1-3-3 Jigozen, Hatsuka-ichi, Hiroshima 738-8503, Japan. oshita-akihiko@umin.ac.jp
Telephone: +81-829-363111 Fax: +81-829-365573
Received: May 23, 2014
Peer-review started: May 26, 2014
First decision: June 18, 2014
Revised: July 3, 2014
Accepted: July 24, 2014
Article in press: July 25, 2014
Published online: February 14, 2015
Processing time: 264 Days and 17.6 Hours
Abstract

A 72-year-old woman with a sigmoid colon cancer and a synchronous colorectal liver metastasis (CRLM), which involved the right hepatic vein (RHV) and the inferior vena cava (IVC), was referred to our hospital. The metastatic lesion was diagnosed as initially unresectable because of its invasion into the confluence of the RHV and IVC. After she had undergone laparoscopic sigmoidectomy for the original tumor, she consequently had 3 courses of modified 5-fluorouracil, leucovorin, and oxaliplatin (mFOLFOX6) plus cetuximab. Computed tomography revealed a partial response, and the confluence of the RHV and IVC got free from cancer invasion. After 3 additional courses of mFOLFOX6 plus cetuximab, preoperative percutaneous transhepatic portal vein embolization (PTPE) was performed to secure the future remnant liver volume. Finally, a right hemihepatectomy was performed. The postoperative course was uneventful. The patient was discharged from the hospital on postoperative day 13. She had neither local recurrence nor distant metastasis 18 mo after the last surgical intervention. This multidisciplinary strategy, consisting of conversion chemotherapy using FOLFOX plus cetuximab and PTPE, could contribute in facilitating curative hepatic resection for initially unresectable CRLM.

Keywords: Initially unresectable; Colorectal liver metastasis; Conversion chemotherapy; Cetuximab; Percutaneous transhepatic portal vein embolization

Core tip: A 72-year-old woman with a sigmoid colon cancer and a synchronous colorectal liver metastasis (CRLM) was referred to our hospital. The metastatic lesion was diagnosed to be initially unresectable. After she had undergone laparoscopic sigmoidectomy for the original tumor, she consequently had 6 courses of modified 5-fluorouracil, leucovorin, and oxaliplatin plus cetuximab, resulting in conversion chemotherapy. Preoperative percutaneous transhepatic portal vein embolization was performed to secure the future remnant liver volume. Finally, a right hemihepatectomy was successfully performed. The postoperative course was uneventful. She had no recurrence for 18 mo. This multidisciplinary strategy could contribute in facilitating curative hepatic resection for initially unresectable CRLM.