A case with liver resection of metastasis from rectal cancer after bevacizumab treatment

The advancement of systemic chemotherapy for colorectal carcinoma has improved a clinical response rate and expanded a possibility of resection, which we thought we could not have been operable at the initial visit. It also improved a prognosis of patients. We report here a case with liver resection of metastasis from rectal cancer followed by bevacizumab treatment.     

巨大肝癌手术切除治疗的远期疗效

背景与目的：巨大原发性肝癌(直径≥10cm)在临床上占有较大的比例,但关于其手术切除治疗的远期疗效报道较少。本研究探讨手术切除治疗巨大肝癌的远期疗效和预后影响因素。方法：回顾性分析我院1964年至1993年经手术切除的173例巨大肝癌患者的病例资料,根据随访结果计算生存率并作单因素及多因素分析。结果：术后3、5和10年累积生存率分别为31．9％、21．8％和8．3％;生存5年以上37例,生存10年以上8例;单因素分析结果表明预后影响因素为性别、术前肝功能Child-Pugh分级、术中肝硬化程度和是否根治性切除;多因素分析得出影响巨大肝癌切除术后远期疗效的独立预后因素为术中肝硬化程度和是否根治性切除。结论：巨大肝癌应积极争取手术切除治疗,术后能否长期生存取决于肝硬化程度和是否根治性切除。     

A case with liver resection of metastasis from rectal cancer after FOLFOX4+bevacizumab treatment

We report a 59-year-old woman with rectal cancer who underwent low anterior resection in March 2007. After curative operation at Stage IIIb(pT3N2M0), multiple liver metastasis was diagnosed in May 2007. Chemotherapy with FOLFOX4+bevacizumab was performed from June to August in 2007, and liver resection(left lobectomy and partial resection)was performed in September 2007. Bevacizumab was newly available from June 2007 in Japan, and liver resection after bevacizumab administration was safely performed.     

Anal cancer with cerebral metastasis: a case report

Carcinoma of the anal canal is a relatively rare cancer with a low propensity for metastasis. A literature review identifies two cases of brain metastases from anal cancer. The authors present the case of a 63-year-old female with poorly differentiated squamous cell carcinoma of the anal canal who presented with a solitary dural-based enhancing lesion of the right parietal area. The patient underwent craniectomy and tumor resection. Histopathology confirmed the cerebral lesion to be a poorly differentiated squamous cell carcinoma, consistent with the known primary tumor of the anal canal. Although exceptionally rare, the presence of a cerebral lesion in a patient with carcinoma of the anal canal should raise the possibility of metastatic disease. Treatment decisions in patients with newly diagnosed dural-based enhancing lesions and known anal cancer should bear in mind the possibility of metastatic disease.     

Four cases of multiple liver metastasis of colorectal cancer treated with hepatic resection after chemotherapy]

Four cases of multiple liver metastasis of colorectal cancer treated with hepatic resection after chemotherapy were investigated. The 4 patients consisted of 3 males and 1 female with a mean age of 67.8 years. Two patients underwent systemic chemotherapy, and the other 2 received hepatic arterial infusion chemotherapy. The effect was PR in all patients, and mean duration until resection was 8.5 months. One patient had lung metastasis and one had recurrence in a local lesion and residual liver after hepatic resection, but all patients remain alive. The longest survival periods in 4 patients who underwent hepatic resection and 13 who did not were 32 and 24 months, respectively. It is suggested that hepatic resection after chemotherapy for multiple liver metastasis of colorectal cancer may be useful for improvement of outcome.     

Predictors of survival after hepatic resection among patients with colorectal liver metastasis

Studies suggest improved survival following resection of colorectal cancer liver metastases (CLMs). We investigated predictors of survival among patients with CLM who underwent hepatic resection using the SEER-Medicare database to identify patients >/=65 years diagnosed with CLM, 1991-2003, who underwent hepatectomy. Cox proportional hazards models were used to identify factors associated with survival after hepatectomy. Of 923 patients with CLM who underwent hepatectomy, 514 were stages I-III and developed CLM>6 months after diagnosis (metachronous), and 409 were stage IV with CLM at diagnosis (synchronous). From the date of hepatectomy, 5 year survival was 22%; younger age, being married, female gender, surgery in an NCI-designated cancer centre, fewer comorbidities, fewer positive lymph nodes, and lower grade were associated with improved survival. Both 5-fluorouracil (5FU)-based chemotherapy and hepatic arterial infusion (HAI) of floxuridine-based chemotherapy following hepatectomy improved survival (HR=0.62, 95% CI: 0.50-0.78; HR=0.51, 95% CI: 0.28-0.97, respectively) in the synchronous, but not metachronous, group. The HR for overall mortality was higher in hospitals with a high vs low procedure volume (0.75, 95% CI: 0.58-0.94). A substantial subgroup of patients with CLM who undergo hepatectomy experiences long-term survival. High hospital procedure volume and use of 5FU-based or HAI-based chemotherapy after resection were associated with improved prognosis.     

Three-time resection of the rib metastasis from hepatocellular carcinoma after two hepatic resections--a case report

A 40s woman, who had undergone hepatic resection twice for hepatocellular carcinoma (HCC), was admitted to our hospital because of a tumor with pain on the right 9th rib. From the findings of chest computed tomography (CT), abdominal CT and bone scintigraphy, we diagnosed the rib metastasis of HCC without any other recurrences. Local resection of the right 9th rib was performed in July 2008. Histologically, the tumor of the rib was diagnosed as the metastasis of HCC. The patient's pain on the right rib was disappeared after the operation. After the rib resection, the recurrence of the remnant of the right 9th rib occurred in June 2009. Local resection of the rib was performed in July 2009. Afterward, the recurrence of the remnant of the right 9th rib occurred again in April 2010. Local resection of the tumor of the same rib was performed in May 2010. The patient is still alive five years after the first hepatectomy. For HCC patients whose intrahepatic lesion or other metastatic lesions are controllable and the metastatic bone lesion is solitary and easily resectable, a resection for bone metastasis from HCC is thus locally effective in patient's pain control.     

Early start of chemotherapy after resection of primary colon cancer with synchronous multiple liver metastases: a case report

The start of chemotherapy treatment usually requires a delay of about 4 weeks after surgical resection in patients with primary colorectal cancer and synchronous distant metastasis. However, there is no evidence to indicate the required length of this delay interval. In addition, there is a chance that a patient may die because postoperative chemotherapy was not started soon enough and a metastatic tumor was able to develop rapidly. Here, we present a case in which combination chemotherapy with capecitabine and oxaliplatin (XELOX) was started within 1 week after a right hemicolectomy for synchronous multiple liver metastases. To our knowledge, this is the first report of the start of chemotherapy, involving treatments such as folinic acid, fluorouracil, and oxaliplatin (FOLFOX); folinic acid, fluorouracil, and irinotecan (FOLFIRI); and XELOX, within 1 week after a colorectal cancer operation with anastomosis. The findings suggest possible changes in the start time of chemotherapy after surgery in the future.     

Adjuvant hepatic arterial infusion after resection of hepatic metastasis from colorectal cancer

We examined retrospectively the efficacy of hepatic arterial infusion (HAI) chemotherapy comparing systemic treatment as adjuvant therapy after the curative resection of hepatic metastasis from colorectal cancer. Seventeen cases of HAI and 8 of the systemic treatment were enrolled in this study. We compared the pattern of recurrent sites and the overall survival rate between the two groups. There was no difference in a patients' background. Intrahepatic recurrence rate was lower and extrahepatic recurrence rate was higher in the HAI group, but not significant. The 1-, 3-, and 5-year overall survival rate was 94, 72, and 49% in the HAI group and 100, 100, and 50% in the systemic treatment group (p = 0.29), respectively. HAI chemotherapy did not contribute to the elongation of survival time in comparison with systemic treatment. This study indicates that there is no efficacy of HAI alone after the resection of hepatic metastasis from colorectal cancer and that there is need to use systemic chemotherapy together with HAI to prevent an extrahepatic recurrence.     

A case whose lung metastasis was detected and resected eleven years after resection of primary colon cancer

In July 1999, a 79-year-old man underwent sigmoidectomy and D3 lymphadectomy for sigmoid colon cancer (ss, n(-), stage II, cur A). In September 2000, hepatectomy of right lobe and cholecystectomy were performed for his liver metastasis. Every three to six months follow-up had been kept since adjuvant chemotherapy (200 mg/day of 5-FU per os for two years) completed. Eleven years and two months after sigmoidectomy (in September 2010), a chest X-ray examination detected a small nodule in upper area of his right lung, which was diagnosed as either primary lung cancer or metastatic lung tumor followed by chest CT scan and PET-CT examination. In November 2010, laparoscopy-assisted partial resection of his right lung was performed. Histochemical examination of the resected lung tumor resulted cytokeratin 7(-), cytokeratin 20(+) and TTF-1(-), confirming its final diagnosis as lung metastasis from sigmoid colon cancer. He has been alive for six months without any recurrence since resection of his lung metastasis. It was a very rare case to have more than ten-year interval between colon cancer resection and detection of its lung metastasis. However, when we diagnosed the patient with lung tumor, who had undergone a colorectal resection, we should consider if he had a lung metastasis from colorectal cancer.     

A case of transverse colon cancer without a recurrence lesion after five years from resection of hepatic metastasis

The treatment of hepatic metastasis of colon cancer was in progress by new biochemical agents. Generally, a resection was the first alternative treatment against hepatic metastasis of colon cancer, but new antitumor agents were more effective than conventional antitumor agents. Disappearance of metastasis for colon cancer treated with only antitumor agents was commenced to report. We were experienced a case of transverse colon cancer without a recurrence lesion after five years from the resection of hepatic metastasis. A case was a 77-year-old man. He was operated against transverse colon cancer in February 2003. Pathological stage was ss, n0, Stage II. In April 2004, serum CEA was increased. CT examination was not detected a hepatic metastasis but ultrasound examination and MRI detected the metastasis at S7 lesion in the liver. In July 2004, he was admitted to S-1 and PSK until October 2004. In December 2004, the lesion of hepatic metastasis was reduced and serum CEA was decreased. But in September 2005, the metastatic lesion was re-grown. A resection for hepatic metastasis was executed in November 2005. After the resection for hepatic metastasis, he was admitted to UFT/ UZEL from January 2006 to October 2006. Present time( June 2011), the lesion of recurrence was not detected by several examinations (CT, MRI, Ultrasound etc).     

A case of esophageal cancer successfully treated by chemoradiotherapy after resection for multiple liver metastasis of sigmoid colon cancer

The patient was a 56-year-old man. Colonoscopic findings showed a cancerous lesion of the sigmoid colon and we performed curative sigmoidectomy. Four months after the operation, abdominal CT scan revealed multiple metastatic lesions in the liver. We performed lateral segmentectomy and partial resection of the S4, S6, S8 segments and cannulation for hepatic arterial infusion chemotherapy. Continuous hepatic arterial infusion chemotherapy with 5-FU (1,000 mg/body/day) was performed for two weeks as a postoperative adjuvant chemotherapy. Immediately after the therapy, endoscopic examination for upper digestive tract showed a 0-lpl type cancer lesion in the middle of the thoracic esophagus. Concurrent chemoradiotherapy with low-dose FP was efficacious and a complete response was obtained. The patient has survived for nine months after the operation without any sign of recurrence. It is suggested that concurrent chemoradiotherapy an effective treatment for esophageal cancer.     

A case of gastric cancer with bilateral ovarian metastasis after gastrectomy performed ovarian resection

The patient was a 51-year-old female, who underwent radical surgery for cancer of remnant stomach in May 2006 (f-T4N0M0P0H0CY0, por 2, Stage IIIA, Cur B). Bilateral ovarian resection was performed in March 2009 for bilateral ovarian metastasis, so called "Krukenberg tumor" with peritoneal dissemination detected with CT scan after one-year adjuvant chemotherapy with S-1 (80 mg/m2, 4 weeks on and 2 weeks off). As of June 2010, she is alive and maintain her status quo after 6 courses of S-1 plus CDDP combination therapy (S-1 80 mg/m2, 3 weeks on, CDDP 60 mg/m2, started at day 8, ended 35 days later) followed by S-1 for residual peritoneal dissemination detected at operation. In ovary metastasis of gastric cancer, even if accompanied by peritoneum metastasis, ovarian resection as a reduction surgery followed by chemotherapy may improve survival.     

A successful case of liver metastasis from gastric cancer treated with S-1 + induced hypertensive hepatic arterial infusion chemotherapy--a case report

We have experienced a successful case of liver metastasis from gastric cancer treated with S-1 plus induced hypertensive hepatic arterial infusion chemotherapy. A 50-year-old man had undergone distal gastrectomy with extended lymphadenectomy for advanced gastric cancer. Although he was given 100 mg/day of S-1 for postoperative adjuvant therapy, an abdominal CT scan showed a liver metastasis at the hepatic segment 6 after 3 courses of adjuvant chemotherapy. Then, intra-arterial hepatic cannulation connecting to a subcutaneously implanted port system was indwelt via left subclavial artery. Mitomycin C (10 mg) was injected through out the induced hypertension with intravenously-administered angiotensin II once a month. After he received three courses of this combination chemotherapy, the liver metastasis has disappeared on CT scan and a complete response (CR) has been maintained.     

Synchronous resection of colorectal primary and hepatic metastasis

Up to 50% of the over 140,000 new colorectal cancer patients will present with synchronous colorectal cancer and liver metastasis. Surgical management of patients with resectable synchronous colorectal hepatic metastasis is complex and must consider multiple factors, including the presence of symptoms, location of primary tumor and liver metastases, extent of tumor (both primary and metastatic), patient performance status, and underlying comorbidities. Possible approaches to this select group of patients have included a synchronous resection of the colorectal primary and the hepatic metastases or a staged resection approach. The available literature regarding the safety of synchronous versus staged approaches confirms that a simultaneous resection may be performed in selected patients with acceptable morbidity and mortality. Perioperative mortality when minor hepatectomies are combined with colorectal resection is consistently ≤5%. Perioperative morbidity varies considerably following both synchronous and staged resections. However, the bulk of the existing literature confirms that simultaneous resections are both feasible and safe when hepatic resections are limited to <3 segments. Data regarding the oncologic outcomes following synchronous versus staged resections for Stage IV colorectal cancer are more limited than those available regarding postoperative morbidity and mortality. The available data suggest equivalent overall and disease-free survival regardless of timing of resection. Experience with minimally invasive combined colorectal and hepatic resections is extremely limited to date and consists exclusively of small single center series. The potential benefits of a minimally invasive approach will await the results of larger studies.Key Words: Colorectal cancer, colorectal liver metastases, synchronous resection     

A case of hepatic arterial infusion chemotherapy with docetaxel for liver metastasis from breast cancer

We experienced a case of hepatic arterial infusion chemotherapy using docetaxel for liver metastasis, which showed no response to CEF therapy, from breast cancer. A 63-year-old woman had undergone modified radical mastectomy for right breast cancer (T2aN1bM0: Stage II) in October, 1995. Six-cycle CMF therapy and toremifene citrate (40 mg/day) were administered as adjuvant therapy, but multiple recurrent tumors in liver, lung, and local site were detected in February 1997. Six-cycle CEF therapy was given for recurrent disease and there was a complete response for lung and local recurrence, but no change in liver metastasis. Chemoendocrine therapies using 5'-DFUR or CMitF in addition to TAM and fadrozole hydrochloride hydrate had developed progressive disease for liver metastasis. A catheter and port kit were operatively inserted and implanted in March 1998. Hepatic arterial infusion of docetaxel (30-40 mg/body/month, one hour administration) was repeated 4 times, once in our clinic. Leukopenia, general fatigue and fever, which were mild and did not require any treatment, appeared as side effects. This treatment reduced multiple liver metastatic sites on abdominal CT finding and was thought to be a partial response. However, the patient had multiple brain metastasis and died on August 2, 1998. While docetaxel, even by systemic administration, has a 36-77% response rate for liver metastasis, arterial infusion might have a good response and mild side effect with a lower dose than by intravenous administration.     

Surgical resection of a cerebral metastasis from cervical cancer: case report and review of the literature

AIMS AND BACKGROUND: Central nervous system metastasis from cervical carcinoma is uncommon. CASE REPORT: We report the case of a 51-year-old woman who developed a solitary cerebral metastasis 29 months after radical hysterectomy with pelvic lymphadenectomy for a stage IB, grade III cervical cancer. The patient suddenly complained of headache, confusion and dizziness; she was submitted to emergency surgical resection of a 2 x 3 cm metastasis in the right frontal lobe. The postoperative course was uneventful and she completely recovered from her neurological deficit. Following surgery the patient underwent careful restaging. Massive bilateral involvement of the pelvic wall was diagnosed, and the patient received three courses of cisplatin-based chemotherapy. She developed liver and lung metastases and died 10 months later of progressive disseminated disease, without, however, any sign of recurrent or persistent cerebral involvement. CONCLUSION: Neurosurgical resection should be considered in cervical cancer patients with solitary brain metastasis in the absence of systemic disease.     

A case report of bilateral liver metastasis from rectal cancer effectively treated with continuous infusion of anti-cancer drugs through hepatic artery

A 52-year-old woman with bilateral liver metastasis originating from rectal cancer was treated with transarterial infusion of cisplatin, MMC, 5-FU and ADM after abdomino-peritoneal resection of the rectum. Cisplatin was infused continuously for 72 hours up to a 150 mg of dose through a Port-A-Cath which was inserted via gastro-duodenal artery at operation. The side effects observed were nausea, vomiting and leukopenia, but renal dysfunction was not encountered. Histology of the rectal lesion revealed poorly differentiated adenocarcinoma. The liver lesions were followed up by Echo, CT and angiography after chemotherapy, which demonstrated remarkable reduction in size or disappearance of the tumors.     

A case report; 5'-DFUR reduced gastric cancer with multiple liver metastasis]

We describe a case of gastric cancer with multiple liver metastasis that clearly decreased in size after administration of 5'-DFUR. The patient (a 63-year-old male) was inoperable because of multiple liver metastasis. 5'-DFUR 600 mg/day reduced the size of the multiple liver tumors (reduction rate 90%, partial response for four months), but the gastric tumor was unaltered. A rapid decrease in alkali-phosphatase indicated reduction of the liver tumors only one week after the initiation of 5'-DFUR.