Case Report
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Mar 27, 2022; 14(3): 260-267
Published online Mar 27, 2022. doi: 10.4240/wjgs.v14.i3.260
Successful treatment with laparoscopic surgery and sequential multikinase inhibitor therapy for hepatocellular carcinoma: A case report
Yutaka Endo, Motohide Shimazu, Tadayuki Sakuragawa, Yusuke Uchi, Motonori Edanami, Ken Sunamura, Soji Ozawa, Naokazu Chiba, Shigeyuki Kawachi
Yutaka Endo, Motohide Shimazu, Tadayuki Sakuragawa, Yusuke Uchi, Motonori Edanami, Ken Sunamura, Soji Ozawa, Department of Surgery, Tama Kyuryo Hospital, Tokyo 1940297, Japan
Naokazu Chiba, Shigeyuki Kawachi, Department of Digestive and Transplantation Surgery, Tokyo Medical University Hachioji Medical Center, Tokyo 1930998, Japan
Author contributions: Endo Y participated in the patient care, conceptualization, data curation, visualization and wrote the original article; Shimazu M participated in the patient care, reviewed the article, and supervised this report; Ozawa S, Kawachi S, Chiba N, Sakuragawa T, Uchi Y, Sunamura K reviewed the article; Edanami M participated in the patient care.
Informed consent statement: Written informed consent was obtained from this patient.
Conflict-of-interest statement: The authors 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: Motohide Shimazu, MD, PhD, Chief Doctor, Department of Surgery, Tama Kyuryo Hospital, 1491 Shimo-oyamadacho, Machida, Tokyo 1940297, Japan. shimazu@tokyo-med.ac.jp
Received: November 30, 2021
Peer-review started: November 30, 2021
First decision: December 26, 2021
Revised: January 8, 2022
Accepted: March 16, 2022
Article in press: March 16, 2022
Published online: March 27, 2022
Processing time: 115 Days and 13.8 Hours
Abstract
BACKGROUND

Hepatocellular carcinoma (HCC) with massive portal vein tumor thrombosis (PVTT) and distant metastasis is considered unresectable. However, due to recent developments in systemic chemotherapy, successful cases of conversion therapy for unresectable diseases have been reported. Herein, we report a successful multidisciplinary approach for treatment of multi-visceral recurrence with sequential multikinase inhibitor and laparoscopic surgery.

CASE SUMMARY

A 63-year-old woman with chronic hepatitis B virus infection was diagnosed with HCC. Subsequently, she underwent two rounds of laparoscopic partial hepatectomy, laparoscopic left adrenalectomy, and transcatheter arterial chemoembolization plus sorafenib for recurrence. Four years after initial hepatectomy, she presented with a 43-mm mass in the spleen and tumor thrombus involving the main portal vein trunk with ascites. Her liver function was Child-Pugh B (8), and protein induced by vitamin K absence or antagonist II (PIVKA II) levels were elevated up to 46.291 mAU/mL. Since initial treatment with regorafenib for three months was unsuccessful, the patient was administered lenvatinib. Ten months post-treatment, there was no contrast enhancement of PVTT or splenic metastasis. Chemotherapy was discontinued due to severe diarrhea. Afterward, splenic metastasis became viable, and PIVKA II increased. Therefore, hand-assisted laparoscopic splenectomy was performed. She experienced no clinical recurrence 14 mo after resection.

CONCLUSION

Conversion surgery after successful multikinase inhibitor treatment might be considered an effective treatment option for advanced HCC.

Keywords: Hepatocellular carcinoma; Lenvatinib; Portal vein; Venous thrombosis; Splenic neoplasms; Case report

Core Tip: A 63-year-old woman had chronic hepatitis B virus infection and previous treatment history of hepatocellular carcinoma. She developed a 43-mm splenic mass and tumor thrombus involving the right portal branch and an umbilical portion extending down to the main trunk with severe ascites. She was initially treated with regorafenib and then lenvatinib. Ten months post-treatment, there was no contrast enhancement of portal vein tumor thrombosis or splenic metastases. However, after lenvatinib discontinuation due to severe diarrhea, splenic metastases showed partial contrast enhancement. Subsequently, hand-assisted laparoscopic splenectomy was performed with no remarkable postoperative complications. She experienced no recurrence for 14 mo.