Yokoo H, Takahashi H, Hagiwara M, Iwata H, Imai K, Saito Y, Matsuno N, Furukawa H. Successful hepatic resection for recurrent hepatocellular carcinoma after lenvatinib treatment: A case report. World J Hepatol 2020; 12(12): 1349-1357 [PMID: 33442460 DOI: 10.4254/wjh.v12.i12.1349]
Corresponding Author of This Article
Hideki Yokoo, MD, PhD, Associate Professor, Division of Hepato-Biliary-Pancreatic Surgery and Transplant Surgery, Department of Surgery, Asahikawa Medical University, 2-1 Midorigaoka-Higashi, Asahikawa 078-8510, Hokkaido, Japan. hidekiyokoo@asahikawa-med.ac.jp
Research Domain of This Article
Surgery
Article-Type of This Article
Case Report
Open-Access Policy of This Article
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/
Hideki Yokoo, Hiroyuki Takahashi, Masahiro Hagiwara, Hiroyoshi Iwata, Koji Imai, Naoto Matsuno, Hiroyuki Furukawa, Division of Hepato-Biliary-Pancreatic Surgery and Transplant Surgery, Department of Surgery, Asahikawa Medical University, Asahikawa 078-8510, Hokkaido, Japan
Yoshinori Saito, Department of Gastroenterology, Asahikawa-Kosei General Hospital, Asahikawa 078-8211, Hokkaido, Japan
Author contributions: Yokoo H, Takahashi H, Hagiwara M, Iwata H, and Imai K were the patient’s hepato-biliary-pancreatic surgeons, reviewed the literature, and contributed to manuscript drafting; Yokoo H, Takahashi H, and Saito Y analyzed and interpreted the imaging findings; Matsuno N and Furukawa H were responsible for the revision of the manuscript for important intellectual content; All authors issued final approval for the version to be submitted.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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/
Corresponding author: Hideki Yokoo, MD, PhD, Associate Professor, Division of Hepato-Biliary-Pancreatic Surgery and Transplant Surgery, Department of Surgery, Asahikawa Medical University, 2-1 Midorigaoka-Higashi, Asahikawa 078-8510, Hokkaido, Japan. hidekiyokoo@asahikawa-med.ac.jp
Received: July 28, 2020 Peer-review started: July 28, 2020 First decision: September 17, 2020 Revised: September 29, 2020 Accepted: October 21, 2020 Article in press: October 21, 2020 Published online: December 27, 2020 Processing time: 142 Days and 7.9 Hours
Abstract
BACKGROUND
Lenvatinib has been shown to be noninferior to sorafenib regarding prognosis and recurrence rate in patients with unresectable hepatocellular carcinoma (HCC) who have not received prior systemic chemotherapy. In patients treated with lenvatinib, 40% of cases achieved sufficient tumor reduction to make potential surgery possible. However, the outcomes of such surgery are unknown. We report a successful case of hepatic resection for recurrent HCC after lenvatinib treatment.
CASE SUMMARY
A 69-year-old man underwent right anterior sectionectomy for HCC in segment 8 of the liver. Ten months later, he was found to have an intrahepatic HCC recurrence that grew rapidly to 10 cm in diameter with sternal bone metastases. After confirming partial response to lenvatinib administration for 2 mo, a second hepatectomy was performed. Pathological examination showed that 80% of the tumor was necrotic. The patient did not develop any adverse effects under lenvatinib treatment. He was discharged at 25 d after surgery. Radiation therapy for bone metastases continued to be given under lenvatinib, and the patient has remained alive for 1 year after the second hepatectomy.
CONCLUSION
The prognosis of patients with recurrent HCC may be improved by liver resection combined with prior lenvatinib therapy.
Core Tip: We report a case of intrahepatic hepatocellular carcinoma recurrence with rapid growth and sternal bone metastases after initial resection. A second surgery was successfully achieved after lenvatinib administration induced tumor shrinkage. Because the patient had bone metastases, multidisciplinary therapy, postoperative radiation therapy, and lenvatinib administration were performed, and the patient remains alive at 1 year postoperatively. In this case, lenvatinib induced a partial response for rapid growth of recurrent hepatocellular carcinoma with bone metastases, and conversion to surgery was successfully achieved for the purpose of controlling the intrahepatic lesion for the first time.
