Case Report
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World J Gastrointest Surg. Jun 27, 2014; 6(6): 107-111
Published online Jun 27, 2014. doi: 10.4240/wjgs.v6.i6.107
Downstaging and resection after neoadjuvant therapy for fibrolamellar hepatocellular carcinoma
Gilton Marques Fonseca, Antonio Drauzio Varella, Fabricio Ferreira Coelho, Emerson Shigueaki Abe, Rodrigo Blanco Dumarco, Paulo Herman
Gilton Marques Fonseca, Fabricio Ferreira Coelho, Emerson Shigueaki Abe, Rodrigo Blanco Dumarco, Paulo Herman, Digestive Surgery Division, Department of Gastroenterology, University of São Paulo School of Medicine, Avenida Doutor Enéas de Carvalho Aguiar 255, Instituto Central, 05403-900, São Paulo, Brazil
Antonio Drauzio Varella, Clinical Oncologist, Hospital Sírio-Libanês, 01308-050, São Paulo, Brazil
Author contributions: Fonseca GM and Herman P designed the study and wrote the manuscript; Fonseca GM, Coelho FF, Abe ES and Dumarco RB performed revision research; Coelho FF, Abe ES, Dumarco RB and Varella AD reviewed the manuscript.
Correspondence to: Gilton Marques Fonseca, MD, Digestive Surgery Division, Department of Gastroenterology, University of São Paulo School of Medicine, Avenida Doutor Enéas de Carvalho Aguiar, 255, Instituto Central, 9° Andar, Sala 9074, 05403-900, São Paulo, Brazil. medgilton@yahoo.com.br
Telephone: +55-11-26617560 Fax: +55-11-26617560
Received: February 20, 2014
Revised: June 4, 2014
Accepted: June 10, 2014
Published online: June 27, 2014
Processing time: 150 Days and 13.8 Hours
Abstract

Fibrolamellar hepatocellular carcinoma (FLHCC) is a rare malignant liver neoplasm, commonly observed in adolescents and young adults of both genders. The disease is more common in Caucasians and in patients without a prior history of liver disease. The best treatment option is a surgical resection associated with liver hilum lymph node dissection. However, there is no established systemic drug treatment for patients with locally advanced or metastatic disease. We report on a patient with advanced FLHCC, initially considered unresectable due to invasion of the right and the middle hepatic veins and circumferential involvement of the left hepatic vein. Following the treatment with gemcitabine-oxaliplatin systemic chemotherapy, the patient exhibited a significant tumor reduction. As a result, a complete resection was performed with an extended right hepatectomy associated with a partial resection of the inferior vena cava, a wedge resection in segment 2, and lymphadenectomy of the hepatic hilum. The case was unusual due to the significant tumor downstaging with gemcitabine-oxaliplatin, potentially enabling curative resection. More studies are needed to confirm the efficacy of the systemic drug treatment for FLHCC.

Keywords: Chemotherapy; Gemcitabine; Oxaliplatin; Hepatectomy; Hepatic veins; Fibrolamellar hepatocellular carcinoma

Core tip: Fibrolamellar hepatocellular carcinoma (FLHCC) is a rare malignant liver neoplasm. The best treatment option is a surgical resection with liver hilum lymph node dissection. Currently there is no established systemic drug treatment for patients with locally advanced or metastatic disease. In this report, a patient with advanced FLHCC, initially considered unresectable due to vascular invasion, exhibited a significant tumor reduction following systemic chemotherapy with gemcitabine-oxaliplatin, allowing resection. This was an unusual case where gemcitabine-oxaliplatin treatment led to a significant tumor downstaging enabling curative resection. Additional studies are needed to confirm the efficacy of the systemic drug treatment for FLHCC.