Case Report
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Sep 27, 2023; 15(9): 2089-2097
Published online Sep 27, 2023. doi: 10.4240/wjgs.v15.i9.2089
Dual transformation therapy for giant hepatocellular carcinoma: Two case reports and review of literature
Qiang Gao, Guang-Zhi Zhu, Chuang-Ye Han, Xin-Ping Ye, Hua-Sheng Huang, Shu-Tian Mo, Tao Peng
Qiang Gao, Guang-Zhi Zhu, Chuang-Ye Han, Xin-Ping Ye, Hua-Sheng Huang, Shu-Tian Mo, Tao Peng, Department of Hepatobiliary Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning 530000, Guangxi Zhuang Autonomous Region, China
Author contributions: Gao Q, Zhu GZ, and Han CY contributed to data curation and writing of the original draft; Ye XP and Huang HS contributed to data curation; Mo ST, and Peng T contributed to manuscript review and editing; all authors have read and approved the final manuscript.
Informed consent statement: Informed written consent was obtained from the patient for the publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest to disclose.
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: Tao Peng, PhD, Chief Doctor, Department of Hepatobiliary Surgery, The First Affiliated Hospital of Guangxi Medical University, No. 6 Shuangyong Road, Nanning 530000, Guangxi Zhuang Autonomous Region, China. pengtaogmu@163.com
Received: May 30, 2023
Peer-review started: May 30, 2023
First decision: July 4, 2023
Revised: July 12, 2023
Accepted: August 1, 2023
Article in press: August 1, 2023
Published online: September 27, 2023
Processing time: 115 Days and 4.8 Hours
Abstract
BACKGROUND

In the translational therapy of giant hepatocellular carcinoma (HCC), hepatic arterial infusion chemotherapy (HAIC) combined with anti-PD-1 immunotherapy and tyrosine kinase inhibitors (TKI) after laparoscopic portal vein ligation (PVL) is extremely rare. This is a dual conversion therapy that combines surgery and oncology. Here, we report two cases of successful surgical completion after dual conversion therapy.

CASE SUMMARY

We report that a 54-year-old man and a 69-year-old woman were diagnosed with primary HCC combined with hepatitis B cirrhosis (case 2 also combined with fatty liver) on physical examination. Due to the insufficient residual liver volume assessed before surgery, laparoscopic right PVL was performed, followed by HAIC combined with anti-PD-1 immunotherapy and TKI. Finally, surgical resection was successfully completed, and pathology confirmed that the tumor was mostly necrotic (90%) in one case, and no live tumor tissue was found in the other case.

CONCLUSION

In the process of surgical transformation, our treatment plan takes into account the control and transformation of oncology at the same time, which is expected to provide more opportunities for radical hepatectomy and improve the prognosis of patients with large liver cancer.

Keywords: Giant hepatocellular carcinoma; Laparoscopic right portal vein ligation; hepatic arterial infusion chemotherapy; Anti-PD-1 immunotherapy; Tyrosine kinase inhibitor; Case report

Core Tip: There have been many clinical studies on translational therapy for giant hepatocellular carcinoma, but simply seeking surgical transformation always carries the risk of tumor progression. There's a combination of control and transformation in oncology either immunotherapy, targeted therapy, or a combination of both. In addition, we added hepatic arterial infusion chemotherapy to seek better prognosis. In addition to the success of surgical transformation in the 2 patients reported by us, the postoperative pathology also suggested good oncology control and transformation. This treatment regimen is promising to provide more opportunities for radical hepatectomy and better prognosis for patients with large liver cancer.