Case Report
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. May 15, 2024; 16(5): 2225-2232
Published online May 15, 2024. doi: 10.4251/wjgo.v16.i5.2225
Multidisciplinary comprehensive treatment of massive hepatocellular carcinoma with hemorrhage: A case report and review of literature
Xian-Shuai Kou, Fan-Fan Li, Yun Meng, Jian-Ming Zhao, Sheng-Fen Liu, Lan Zhang
Xian-Shuai Kou, Jian-Ming Zhao, The First Clinical Medical College, Gansu University of Chinese Medicine, Lanzhou 730000, Gansu Province, China
Fan-Fan Li, Department of Thoracic Surgery, The First Hospital of Lanzhou University, Lanzhou 730000, Gansu Province, China
Yun Meng, Department of Surgery, Gansu Provincial Hospital, Lanzhou 730000, Gansu Province, China
Sheng-Fen Liu, Lan Zhang, Department of Orthopedics, Gansu Provincial Hospital, Lanzhou 730000, Gansu Province, China
Co-first authors: Xian-Shuai Kou and Fan-Fan Li.
Co-corresponding authors: Lan Zhang and Sheng-Fen Liu .
Author contributions: Kou XS and Li FF wrote the manuscript, acquired the data, and were integral in the analysis and interpretation of the data; Meng Y also contributed to manuscript writing while overseeing the project; Zhao JM provided support in the data collection; Liu SF and Zhang L was pivotal inleading project development, managing operations, and providing additional supervision. All the authors have significantly contributed to the manuscript and have given their approval for the submitted version. The reasons for designating Kou XS and Li FF as co-first authors are threefold. First, this study was conducted as a collaborative effort, and both authors spent a lot of time and effort to complete the study and the final paper, assuming the same responsibilities and burdens. Second, the two authors from different fields with various expertise and skills improved the quality and reliability of the paper. Ultimately, Kou XS and Li FF made equal efforts to communicate and collaborate throughout the research process. Liu SF and Zhang L co-directed the writing of the paper, jointly reviewed the authenticity of the data, and supervised the writing and completion of the paper. They played a key role in developing the project, managing its operation, and providing additional oversight. In summary, we believe that the designation of Kou XS and Li FF and Fan-fanLi as co-first authors and Liu SF and Zhang L as co-corresponding authors is appropriate for our manuscript because it reflects the spirit of cooperation and equality of our team.
Supported by Gansu Provincial Hospital Internal Medicine Research Fund Project, No. 22GSSYD-47; "Innovation Star" Project for Graduate Students of Gansu University of Chinese Medicine, No. 2023CXZX-756; and the Natural Science Foundation of Gansu Province, No. 21JR11RA187.
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: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Lan Zhang, PhD, Nurse, Department of Orthopedics, Gansu Provincial Hospital, No. 204 Donggang West Road, Chengguan District, Lanzhou 730000, Gansu Province, China. 119238958@qq.com
Received: December 17, 2023
Peer-review started: December 17, 2023
First decision: January 10, 2024
Revised: January 30, 2024
Accepted: March 5, 2024
Article in press: March 5, 2024
Published online: May 15, 2024
Processing time: 143 Days and 23.1 Hours
Abstract
BACKGROUND

Hepatocellular carcinoma (HCC), a major contributor to cancer-related deaths, is particularly prevalent in Asia, largely due to hepatitis B virus infection. Its prognosis is generally poor. This case report contributes to the medical literature by detailing a unique approach in treating a large HCC through multidisciplinary collaboration, particularly in patients with massive HCC complicated by ruptured bleeding, a scenario not extensively documented previously.

CASE SUMMARY

The patient presented with large HCC complicated by intratumoral bleeding. Treatment involved a multidisciplinary approach, providing individualized care. The strategy included drug-eluting bead transarterial chemoembolization, sorafenib-targeted therapy, laparoscopic partial hepatectomy, and standardized sintilimab monoclonal antibody therapy. Six months after treatment, the patient achieved complete radiological remission, with significant symptom relief. Imaging studies showed no lesions or recurrence, and clinical assessments confirmed complete remission. This report is notable as possibly the first documented case of successfully treating such complex HCC conditions through integrated multidisciplinary efforts, offering new insights and a reference for future similar cases.

CONCLUSION

This study demonstrated effective multidisciplinary treatment for massive HCC with intratumoral bleeding, providing insights for future similar cases.

Keywords: Hepatocellular carcinoma, Transarterial chemoembolization, Sintilimab, Sorafenib, Translational therapy, Multidisciplinary team, Case report

Core Tip: In this study, a unique multidisciplinary approach was demonstrated for treating a patient with massive hepatocellular carcinoma (HCC) complicated by hemorrhage. Treatment included combined drug-eluting bead transarterial chemoembolization, targeted therapy, laparoscopic surgery, and monoclonal antibody therapy. This method achieved complete radiological remission and significant symptom relief, offering a novel and effective strategy for managing complex HCC patients. This report provides valuable insights for the treatment of similar conditions, paving the way for future clinical practice.