Abstract
In this case report, the authors aim to demonstrate the success of recent methods in the radical treatment of a patient with primary inoperable liver and subsequent colorectal cancer pulmonary metastases. A 75 year old patient with inoperable bulky metastasis in the right hepatic lobe and insufficient future remnant liver volume was indicated for a stage procedure in the liver parenchyma. Embolization of the right branch of the portal vein was first performed with subsequent administration of stem cells into the contralateral liver lobe. Following compensatory growth of the left liver lobe, right-sided hepatectomy was performed with subsequent adjuvant oncological treatment. Six months after the surgery, a metastasis developed in the right pulmonary lobe which was solved by metastasectomy. The patient, one year after the diagnosis of inoperable liver metastasis, is completely healthy and free of signs of disease recurrence. A comprehensive oncosurgical approach using up-to-date diagnostic and treatment options may offer patients with metastatic colorectal cancer, radical treatment with the hope of long-term quality survival.
Highlights
Surgical treatment of colorectal cancer liver metastases (CLMs) is a gold standard offering patients quality long-term survival
Due to the borderline future remnant liver volume of the liver parenchyma (FRLV) we decided to perform a phase procedure which consisted of embolization of the right branch of the portal vein (PVE), followed by subsequent leukapheresis, application of hematopoietic stem cells (HSC) and right hepatectomy
An insufficient FRLV is generally considered as the volume of healthy liver of less than 30%
Summary
Surgical treatment of colorectal cancer liver metastases (CLMs) is a gold standard offering patients quality long-term survival. From our own experience and the literature, a five-year survival in radically operated patients (R0 resection) is achieved in 35-60% of cases[1,2,3]. A large percentage (up to 80%) of patients diagnosed with CLMs are primarily inoperable due to the extent and location of metastases in the liver and body. In some patients with primarily surgically inoperable cancer whose life expectancy is very short, we can significantly extend their quality of life by means of procedures that result in the final radical surgery
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