Successful Multidisciplinary Treatment with Laparoscopic Surgery and Sequential Multikinase Inhibitor Therapy for Multivisceral Recurrence of Hepatocellular Carcinoma

Abstract

Background: Hepatocellular carcinoma with massive portal vein tumor thrombosis and distant metastasis is considered unresectable. However, due to recent developments in systemic chemotherapy, successful cases of conversion therapy for unresectable diseases have been reported. Herein, we report a successful multidisciplinary treatment of sequential multikinase inhibitor and laparoscopic surgery for multivisceral recurrence. Case presentation: A 63-year-old woman with chronic hepatitis B virus infection was diagnosed with liver tumor. Subsequently, she underwent two rounds of laparoscopic partial hepatectomy, laparoscopic left adrenalectomy, and transcatheter arterial chemoembolization and sorafenib for recurrence. Four years after the initial hepatectomy, she was found to have a 43 mm mass in the spleen and a tumor thrombus that involved the right anterior portal branches down to the main trunk with severe ascites. Her liver function was Child-Pugh B (8), and PIVKA II levels were elevated up to 46,291 mAU/mL. The patient was initially treated with regorafenib but experienced disease progression 3 months later with a maximum PIVKA II value of 129,815 mAU/mL. The patient was then administered lenvatinib. Eighteen months after the treatment, there was no contrast enhancement of the portal vein tumor thrombosis and splenic metastasis. This chemotherapy was discontinued because of grade 3 diarrhea. Afterward, splenic metastasis increased again with the rise in PIVKA II. Therefore, hand-assisted laparoscopic splenectomy was performed. The patient was discharged 10 days postoperatively. There was no clinical evidence of recurrence 14 months after resection. Conclusion: Conversion surgery after successful multikinase inhibitor treatment is considered an effective treatment option for advanced HCC.