Huge hepatocellular carcinoma with extrahepatic collateral arteries successfully treated by multidisciplinary treatment
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CASE REPORT
Huge hepatocellular carcinoma with extrahepatic collateral arteries successfully treated by multidisciplinary treatment including laparoscopic devascularization: a case report Kensuke Yamamura1 · Toru Beppu1 · Nobutaka Sato1 · Eri Oda1 · Koichi Kinoshita1 · Hideaki Yuki2 · Toshihiko Motohara3 · Hideaki Miyamoto4 · Tsutomu Oda5 · Shinichi Akahoshi1 Received: 16 September 2020 / Accepted: 25 October 2020 © Japanese Society of Gastroenterology 2020
Abstract Multidisciplinary treatment is recommended for the management of patients with advanced hepatocellular carcinoma (HCC). Some operative decollateralization of extrahepatic feeding arteries with laparotomy have been introduced for HCC. We herein newly develop laparoscopic devascularization (LDEV) to continue transarterial chemoembolization (TACE) for HCC with extrahepatic collateral arteries. A 74-year-old man with multiple huge HCC (4 tumors, 18 cm in diameter) and poor liver function (non-alcoholic steatohepatitis, Child–Pugh score 7) was treated with 6 times of chemoembolization in combination with LDEV, 3 times of ablation therapies, and lenvatinib therapy. His tumor markers were triple positive (AFP, 12,906.5 ng/ ml; PIVKA-II, 491,743 mAU/ml; AFP-L3, 91.8%) before treatments; however, they all returned to normal limits. Complete response was achieved according to the modified RECIST criteria. Unfortunately, he died 6 months after the final treatment with no recurrence of HCC due to the postoperative complication of primary lung cancer. LDEV is a useful tool to continue effective TACE, and multidisciplinary treatment including chemoembolization and LDEV can cure advanced HCC patients with extrahepatic collaterals and impaired liver function. Keywords Hepatocellular carcinoma · Laparoscopic devascularization · Extrahepatic collateral artery · Transarterial chemoembolization · Case report Abbreviations HCC Hepatocellular carcinoma TACE Transarterial chemoembolization RFA Radiofrequency ablation MWA Microwave ablation DEB-TACE TACE with drug-eluting beads HALED Hepatic artery ligation and extrahepatic collaterals division * Toru Beppu tbeppu@yamaga‑mc.jp 1
Department of Surgery, Yamaga City Medical Center, 511, Yamaga, Kumamoto 861‑0593, Japan
2
Department of Radiology, Yamaga City Medical Center, Kumamoto, Japan
3
Department of Gastroenterology, Yamaga City Medical Center, Kumamoto, Japan
4
Department of Medical Oncology, Yamaga City Medical Center, Kumamoto, Japan
5
Oda Surgical Clinic, Kumamoto, Japan
mRECIST Modified response evaluation criteria in solid tumors LDEV Laparoscopic devascularization CT Computed tomography FIB-4 Fibrosis-4 index M2BPGi Mac-2-binding protein glycan isomer AFP Alpha-fetoprotein PIVKA-II Protein induced by vitamin K absence or antagonist-II CSL Cisplatin suspended in lipiodol
Introduction Multidisciplinary treatment is recommended for the management of patients with advanced hepatocellular carcinoma (HCC) [1, 2]. Ablation therapy, transarterial chemoembolization (TACE), and molecular t
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