Abstract
A 70-year-old male patient was admitted for treatment of metachronous colorectal liver metastasis (CRLM). A solitary, 6-cm CRLM was detected in segments 1/8. Enhanced CT demonstrated two enlarged lymph nodes (LN): one phrenic and mediastinal, 2 cm, and the other para-aortic, 1.5 cm. Initially, the para-aortic LN was totally removed and was histologically diagnosed as CRLM metastasis. Ten courses of folinic acid (5-FU) and oxaliplatin (FOLFOX) were administered. After 6-month observation, the enlarged phrenic and mediastinal LNs had completely resolved. The previously elevated serum CEA returned to normal range. An extended anterior sectionectomy was successfully completed. The patient underwent two courses of adjuvant FOLFOX. After approximately 5 years, the suspiciously similar phrenic and mediastinal LNs were detected. Endoscopic ultrasound-fine-needle biopsy confirmed LN metastasis. After six courses of FOLFOX + bevacizumab, the recurrent regional LN was totally resected. The presence of a regional para-aortic LN metastasis from CRLM has been reported to be a complete contraindication to a surgical approach because there have been no 5-year survivors. However, this patient has now been doing well without any recurrence for more than 7 years. This regional LN metastasis possibly occurred directly, without involvement of the hepatoduodenal ligament node, just like sentinel LN metastasis.
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