Case Report
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Dec 14, 2016; 22(46): 10249-10253
Published online Dec 14, 2016. doi: 10.3748/wjg.v22.i46.10249
“En bloc” caudate lobe and inferior vena cava resection following cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for peritoneal and liver metastasis of colorectal cancer
Patricia Sánchez-Velázquez, Nicolas Moosmann, Ingolf Töpel, Pompiliu Piso
Patricia Sánchez-Velázquez, Pompiliu Piso, Department of Surgery, Barmherzige Brüder Krankenhaus Regensburg, 93049 Regensburg, Germany
Nicolas Moosmann, Department of Oncology and Hematology, Barmherzige Brüder Krankenhaus Regensburg, 93049 Regensburg, Germany
Ingolf Töpel, Department of Vascular Surgery, Barmherzige Brüder Krankenhaus Regensburg, 93049 Regensburg, Germany
Author contributions: All authors reviewed and supervised the manuscript; Sánchez-Velázquez P wrote the main manuscript text; Piso P was in collaboration with Moosmann N; Töpel I has supervised the design, develop and main content of the manuscript.
Institutional review board statement: This case report was approved by the Institutional Review Board standards.
Informed consent statement: The patient involved in this study gave her informed consent authorizing use and disclosure of her protected health information
Conflict-of-interest statement: The authors declare no conflict of interests.
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: Patricia Sánchez-Velázquez, MD, Department of Surgery, Barmherzige Brüder Krankenhaus Regensburg, Prüfeningerstrasse 86, 93049 Regensburg, Germany. patri_sv5@hotmail.com
Telephone: +49-941-3692205
Received: August 2, 2016
Peer-review started: August 2, 2016
First decision: August 29, 2016
Revised: September 10, 2016
Accepted: September 28, 2016
Article in press: September 28, 2016
Published online: December 14, 2016
Processing time: 132 Days and 22.3 Hours
Abstract

There are diverse protocols to manage patients with recurrent disease after primary cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) for peritoneal carcinomatosis. We describe a case of metachronous liver metastasis after CRS and HIPEC for colorectal cancer, successfully treated with a selective metastectomy and partial graft of the inferior vena cava. A 35-year-old female presented with a large tumour in the cecum and consequent colonic stenosis. After an emergency right colectomy, the patient received adjuvant chemotherapy. One year later she was diagnosed with peritoneal carcinomatosis, and it was decided to carry out a CRS/HIPEC. After 2 years of total remission, an isolated metachronous liver metastasis was detected by magnetic resonance imaging surveillance. The patient underwent a third procedure including a caudate lobe and partial inferior vena cava resection with a prosthetic graft interposition, achieving an R0 situation. The postoperative course was uneventful and the patient was discharged on postoperative day 17 after the liver resection. At 18-mo follow-up after the liver resection the patient remained free of recurrence. In selected patients, the option of re-operation due to recurrent disease should be discussed. Even liver resection of a metachronous metastasis and an extended vascular resection are acceptable after CRS/HIPEC and can be considered as a potential treatment option to remove all macroscopic lesions.

Keywords: Cytoreductive surgery; Liver resection; Hyperthermic intraperitoneal chemotherapy; Colorectal cancer; Liver metastasis

Core tip: Treatment of liver recurrence after a cytoreductive surgery and hyperthermic intraperitoneal chemotherapy is a great challenge. We report here the case of a young patient with metachronous liver metastases who was treated with a limited resection of segment I of the liver and vascular graft interposition of the inferior vena cava achieving a long-term survival. The surgical approach of these patients is extremely complicated and often requires complex major surgical procedures.