Abstract
BackgroundLenvatinib is a novel tyrosine kinase inhibitor that exhibits an antitumor effect on hepatocellular carcinoma (HCC). An established strategy that involves surgery and usage of lenvatinib for advanced HCC remains elusive.Case presentationA 58-year-old male patient with advanced HCC and untreated hepatitis B was referred to our hospital. The tumor at the right lobe was 10 cm in diameter with right portal vein thrombus. Because of the possible lung metastasis and concern about the remaining hepatic function after extended right hepatectomy, lenvatinib was initiated before surgery. After the confirmation of a sharp decrease of tumor markers during the 3-week lenvatinib therapy, only a right portal vein transection was done leaving the enlargement of the left lobe for improved post-hepatectomy liver function while lenvatinib therapy was continued. The laparotomy revealed that the tumor was invading the right diaphragm. After 7 weeks of lenvatinib administration after right portal vein transection, an extended right hepatectomy with resection of the tumor-invaded diaphragm was successfully done. The lung nodules that were suspected as metastases had disappeared. The patient has been doing well without any sign of recurrence for 1 year.ConclusionThe strategy involving the induction of lenvatinib to conversion hepatectomy including the portal vein transection was effective for advanced HCC.
Highlights
BackgroundHepatocellular carcinoma (HCC) is the third leading cause of death worldwide, with incidence continuing to increase [1, 2]
Lenvatinib is a novel tyrosine kinase inhibitor that exhibits an antitumor effect on hepatocellular carcinoma (HCC)
The strategy involving the induction of lenvatinib to conversion hepatectomy including the portal vein transection was effective for advanced HCC
Summary
Hepatocellular carcinoma (HCC) is the third leading cause of death worldwide, with incidence continuing to increase [1, 2]. A strategy that combines surgery with lenvatinib for advanced HCC has not yet been established In this case, we report a case of hepatocellular carcinoma undergoing extended right hepatectomy after right portal vein transection and lenvatinib therapy. We decided to do portal vein transection and continue further lenvatinib therapy after that Even at this moment, the estimated liver remnant volume was not enough (estimated liver remnant volume: 482 mL, 40.3% of total liver volume), and we were reluctant to do an extended right hepatectomy. Estimated liver volume showed only a slight increase, we decided to perform the operation not to lose the chance of conversion hepatectomy He underwent an extended right hepatectomy with partial resection of the left medial segment and a part of the right diaphragm 2 months after the initial right portal vein transection (Fig. 5).
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