Yang CW, Zhang RX, Zheng XL, Zhu L, Zheng Z, Wu XH. Long-term survival after combined hepatectomy and colectomy for ruptured combined hepatocellular-cholangiocarcinoma with direct colonic invasion: A case report. World J Gastrointest Oncol 2026; 18(7): 118212 [DOI: 10.4251/wjgo.v18.i7.118212]
Corresponding Author of This Article
Zhi Zheng, MD, Chief Doctor, Department of Hepatobiliary Surgery, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, No. 26 Shengli Street, Jiang’an District, Wuhan 430014, Hubei Province, China. 13907164203@163.com
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Surgery
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case-report
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Yang CW, Zhang RX, Zheng XL, Zhu L, Zheng Z, Wu XH. Long-term survival after combined hepatectomy and colectomy for ruptured combined hepatocellular-cholangiocarcinoma with direct colonic invasion: A case report. World J Gastrointest Oncol 2026; 18(7): 118212 [DOI: 10.4251/wjgo.v18.i7.118212]
World J Gastrointest Oncol. Jul 15, 2026; 18(7): 118212 Published online Jul 15, 2026. doi: 10.4251/wjgo.v18.i7.118212
Long-term survival after combined hepatectomy and colectomy for ruptured combined hepatocellular-cholangiocarcinoma with direct colonic invasion: A case report
Chong-Wei Yang, Ri-Xin Zhang, Xiao-Lin Zheng, Ling Zhu, Zhi Zheng, Xin-Hua Wu, Department of Hepatobiliary Surgery, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430014, Hubei Province, China
Chong-Wei Yang, Ri-Xin Zhang, Xiao-Lin Zheng, Ling Zhu, Zhi Zheng, Xin-Hua Wu, Key Laboratory for Molecular Diagnosis of Hubei Province, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430014, Hubei Province, China
Co-first authors: Chong-Wei Yang and Ri-Xin Zhang.
Co-corresponding authors: Zhi Zheng and Xin-Hua Wu.
Author contributions: Yang CW collected the data and drafted the manuscript; Zhang RX performed the surgery and revised the manuscript; Yang CW and Zhang RX contributed equally to this article, they are the co-first authors of this manuscript; Zheng XL performed the surgery and clarified the treatment plan for the patient; Zhu L clarified the final treatment plan and supervised the study; Zheng Z revised the manuscript, provided financial support and is the corresponding author responsible for journal communication; Wu XH revised the manuscript, conducted data analysis; Zheng Z and Wu XH contributed equally to this article, they are the co-corresponding authors of this manuscript; and all authors have read and approved the final manuscript.
AI contribution statement: We used AI tools (including Doubao and DeepSeek) during manuscript preparation. AI tools were only used for language polishing, translation, and writing assistance, not for data analysis.
Informed consent statement: Informed written consent was obtained from the patient.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
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).
Corresponding author: Zhi Zheng, MD, Chief Doctor, Department of Hepatobiliary Surgery, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, No. 26 Shengli Street, Jiang’an District, Wuhan 430014, Hubei Province, China. 13907164203@163.com
Received: December 29, 2025 Revised: February 25, 2026 Accepted: April 1, 2026 Published online: July 15, 2026 Processing time: 192 Days and 5.5 Hours
Abstract
BACKGROUND
Spontaneous rupture is a life-threatening complication of liver cancer. Cases involving direct tumor invasion of adjacent organs, such as the colon, pose major management challenges and are associated with extremely poor prognoses. This report describes a successful multidisciplinary approach to such a rare clinical scenario.
CASE SUMMARY
We present the case of a 69-year-old man with a giant ruptured liver cancer in the right lobe with direct colonic invasion. The patient was initially stabilized with transarterial embolization. After multidisciplinary discussion and preoperative optimization, he successfully underwent en bloc right hepatectomy combined with right colectomy, cholecystectomy, and intraoperative peritoneal chemotherapy on post-rupture day 19 (the fifth day after admission to our institution). The postoperative course was uneventful. Pathological examination confirmed a combined hepatocellular cholangiocarcinoma with focal invasion into the colonic subserosa. Subsequently, the patient received adjuvant therapy consisting of transarterial chemoembolization, lenvatinib, and tislelizumab for occult intrahepatic micrometastases detected 1.5 months postoperatively. During 42 months of follow-up, the patient’s tumor markers normalized, and surveillance imaging showed no evidence of tumor activity.
CONCLUSION
Aggressive surgical resection combined with multimodal adjuvant therapy may achieve favorable long-term survival in patients with ruptured liver cancer with colonic invasion.
Core Tip: This study reports a successful case of staged multidisciplinary management for a life-threatening ruptured liver cancer with direct colonic invasion, pathologically confirmed as combined hepatocellular cholangiocarcinoma, a rare and aggressive histological subtype. The strategy involved initial embolization, followed by combined organ resection and modern adjuvant therapy, achieving over 42 months of long-term survival. The key finding is that tumor rupture should not be considered an absolute contraindication to curative treatment, and that aggressive surgical resection integrated with modern multimodal therapy can significantly improve outcomes even in such advanced cases.
