Synchronous Multiple Liver Metastases Research Articles

An aggressive surgical approach to rare central biliary invasion of colon cancer

Central biliary metastasis from colorectal cancer (CRC) is a rare manifestation. Given the rarity of the lesion, cases with central biliary metastasis from CRC pose challenges in identifying the proper treatment strategy. We present a case of stage IV CRC with synchronous multiple liver metastases and central biliary invasion. We also conducted a literature search and reviewed the reports on central biliary metastasis of CRC treated by major hepatectomy combined with extrahepatic bile duct resection. The patient underwent colon resection, partial hepatectomy, and transileocecal portal embolization (TIPE) as the first procedure, which was followed by an extended right hepatectomy and extrahepatic bile duct resection. Adjuvant chemotherapy was introduced, and the patient was doing well with no recurrence at 17 months after the first procedure. A liberal radical and aggressive resection in a multimodal treatment strategy could offer a favorable outcome in patients with a rare central biliary manifestation of CRC.

Ramucirumab combined with paclitaxel as the second-line chemotherapy for elderly patients with disseminated gastric cancer

Gastric cancer is the third leading cause of cancer-related deaths worldwide. The prognosis of advanced gastric cancer remains poor despite therapeutic advances in recent decades. Several recent positive phase III trials established the efficacy of second-line chemotherapy for metastatic gastric cancer in prolonging overall survival. Many targeted-therapies failed to show a significant survival benefit in GC, only 2 of them are approved FDA: trastuzumab in the 1-st line treatment of HER2-positive gastric cancer and ramucirumab with or without paclitaxel as second line chemotherapy. The article presents the case of effective treatment of patient with Her2-negative advanced gastric cancer. A 76-year-old man had a moderately differentiated adenocarcinoma of gastric with synchronous multiple liver metastases. He received ramucirumab with paclitaxel as second -line chemotherapy. The size of the liver metastases was reduced and he maintained a partial response for one year. This clinical case report demonstrates that new option in the treatment of advanced gastric cancer can to allow our patients to live longer without losing the quality of life.

Pancreatic neuroendocrine tumor with metastasis to the spleen: a case report

BackgroundLong-term term survival in patients with pancreatic neuroendocrine tumors has been reported, even in patients with metastatic disease. Metastases to the spleen are extremely rare, but have been reported from a number of primary malignancies, such as breast cancer, lung cancer, melanoma and ovarian cancer. This is the first report of a splenic metastasis from a primary pancreatic neuroendocrine tumor.Case presentationThe patient presented as a 53 years old white male with anemia and fatigue. Physical examination revealed a left upper quadrant fullness and computed tomography showed a 24 cm left upper quadrant mass with multiple liver metastases, splenomegaly and a 1 cm mass in the spleen. Resection of the primary pancreatic tumor (T4N0M1) was accompanied by gastrectomy, splenectomy and resection of adherent bowel. The spleen contained a metastatic lesion 1.0 cm in diameter, consistent with a primary neuroendocrine tumor of the pancreas. This operation was followed 8 months later, by delayed resection of liver metastases. The patient receives monthly administration of somatostatin long-acting analogue and has undergone several ablations of liver lesions with percutaneous radiofrequency ablation as well as a second liver resection. The patient is alive seven years after initial presentation, with no evidence of disease on imaging studies.ConclusionsThis is the first report of a splenic metastasis from a primary pancreatic neuroendocrine tumor. The patient initially presented with synchronous multiple liver metastases and a single splenic metastasis. After resection of the primary tumor and spleen, the patient has undergone aggressive cytoreductive surgery/ablation of liver lesions and somatostatin therapy with resulting long-term survival.

One-stage operations in patients having colorectal cancer with synchronous multiple liver metastases

One-stage operations in patients having colorectal cancer with synchronous multiple liver metastases

Pathological complete response after neoadjuvant chemotherapy for rectal cancer with synchronous multiple liver metastases: a report of an unusual case.

BackgroundSystemic chemotherapy for stage IV colorectal cancer has advanced markedly in the recent years. We report an unusual case of 13 synchronous liver metastases for which a pathological complete response was achieved with neoadjuvant chemotherapy (NAC) consisting of a combination of 5-fluorouracil (5-FU), oxaliplatin, leucovorin (mFOLFOX6), and bevacizumab.Case presentationA 44-year-old man was diagnosed with colorectal cancer with synchronous liver metastases. We resected the primary rectal tumor first. Further, after providing NAC for hepatic metastases, lateral segmentectomy and partial resection of the liver were performed. The subsequent result was compatible with a complete pathological response. The postoperative course was uneventful, and the patient is currently alive 5 years after the first surgery without evidence of recurrence and without adjuvant chemotherapy.ConclusionsFor patients with initially resectable colorectal liver metastases, the survival benefits of NAC are still unclear. We report a rare case of 13 synchronous liver metastatic lesions from rectal cancer with a complete pathological response after neoadjuvant bevacizumab-containing chemotherapy.

Abstract 510: A novel circulating cell free DNA-based assay in colorectal cancer patients during treatment with systematic chemotherapy

Abstract Introduction: Although circulating cell-free DNA (cfDNA) in blood plasma is being touted as a frontier noninvasive approaches, its clinical utility still remains questionable. The purpose of this study was to compare the efficacy of cfDNA by comparing blood CEA levels and radiological evaluation in patients with unresectable metastatic colorectal cancer (mCRC) who received systemic chemotherapy. Experimental Procedures: In this study, we measured aberrant cancer-specific methylation in cfDNA and the concentration of cfDNA in plasma obtained following each treatment cycle of systemic chemotherapy in three patients with mCRC. To analyze aberrant cancer-specific methylation, we used a modified highly sensitive assay for bisulfite DNA followed by fluorescence-based PCR, as reported previously (JNCI 2009). This methodology can detect methylation status in eight regions, therefore both recovery score (RS) and methylation score (MS), ranged from 0-8 at a given time. We measured RS and MS two-times in each plasma specimen obtained before administration of systemic chemotherapies. Results: In this pilot study, we examined a series of blood plasma obtained from three patients who received oxaliplatin-based chemotherapy together with molecularly-targeted agents. Despite initial tumor shrinkage in the metastases, all patients ultimately developed progressive disease (PD). Patient1 had wild-type KRAS, but had developed a sigmoid colon cancer with synchronous multiple liver and lung metastases. In contrast, Patient2 had mutant KRAS with sigmoid colon cancer and synchronous multiple liver metastasis. Both patients 1 and 2, demonstrated decreasing levels of CEA after the first-line chemotherapy, along with low methylation scores and concentration of cfDNA. Interestingly, in both patients, MS and concentration level of cfDNA increased prior to radiographic documentation of PD. Patient3 harbored BRAF V600E mutation, and a cancer in the ascending colon with systemic lymph node metastasis. Although, in this case, the tumor development progressed rapidly, similar to patients 1 and 2, MS and the concentration levels of cfDNA also increased prior to radiographic documentation of rapid PD. Conclusions: Our novel DNA methylation and concentration-based monitoring assay is a novel methodology for capturing DNA methylation in circulating cell-free DNA in plasma, and is useful for the early identification of colorectal cancer patients who are at risk of developing PD prior to radiographic documentation. Citation Format: Toshiaki Toshima, Takeshi Nagasaka, Yoshiko Mori, Takashi Kawai, Tomokazu Fuji, Fumitaka Taniguchi, Keisuke Kimura, Kazuya Yasui, Hiroyuki Kishimoto, Yuzo Umeda, Hiroshi Tazawa, Ajay Goel, Toshiyoshi Fujiwara. A novel circulating cell free DNA-based assay in colorectal cancer patients during treatment with systematic chemotherapy. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr 510.

I-stage resection of colon cancer and synchronous liver metastasis after conversion therapy

Objective To investigate the safety and clinical effect of Ⅰ-stage resection of colon cancer and synchronous liver metastasis after conversion therapy. Methods The retrospective descriptive study was adopted. The clinical data of 1 patient with sigmoid cancer with synchronous multiple liver metastases who was admitted to the Zhongshan Hospital of Fudan University in April 2013 were collected. The patient was diagnosed as sigmoid cancer with multiple lymph nodes surrounding colon and 5 metastatic lesions found in liver by preoperative imaging examination, and the maximum diameters of 2 metastatic lesions were 4.5 cm and 3.6 cm. The pathological results of colonoscopy indicated adenocarcinoma. After discussion of the multidisciplinary team, liver metastatic lesions were significantly reduced through mFOLFOX6 chemotherapy combined with bevacizumab treatment, and then patient underwent Ⅰ-stage resection of colon cancer with synchronous liver metastasis by the surgical procedures of partial hepatectomy+ 3D laparoscopy-assisted radical resection of sigmoid cancer. The patient received convention treatment of antibiotic, nutrition support therapy and mFOLFOX6 adjuvant chemo-therapy. The changes of lesions in liver and tumor markers were observed by tumor marker test, abdominal/pelvic CT and MRI in the upper abdomen after conversion therapy. The operation time, volume of intraoptrative blood loss, number of lymph nodes dissected and vital sign were observed in the operation. The liver function, time for out-off-bed activity, time to anal exsufflation, time of drainage tube removal, duration of hospital stay, complications, results of pathological examination and recurrence and metastasis of tumor were observed after operation. After discharge from hospital, the patient underwent monthly tumor marker test, B ultrasound and chest X-ray examination till January 2014 and abdominal/pelvic CT, magnetic resonance imaging (MRI) in the upper abdomen and colonoscopy every 6 months. The follow-up of outpatient examination and telephone interview was performed to detect the recurrence and metastasis of tumor up to September 2015. Results After preoperative 4-cycle chemotherapy, the diameters of 2 metastatic lesions in liver reduced to 3.2 cm and 2.0 cm, the levels of carcinoembryonic antigen(CEA) and CA19-9 (tumor marker) were reduced to 95.9 μg/L and 252.4 kU/L. The patient underwent successful Ⅰ-stage resection of colon cancer and synohronous liver metastasis. The operation time, volume of intraoperative blood loss, numbers of lymph nodes dissected and cancerous nodes were 208 minutes, 250mL, 14 and 1, respectively.The patient had no blood transfusion and metastasis, with the stable vital signs and good postoperative recovery. The levels of alanine transaminase (ALT) and aspartate transaminase (AST) were 1 147 U/L and 2 631 U/L at postoperative day 1, 101 U/L and 37 U/L at postoperative day 7, respectively. The out-off-bed activity, anal exsufflation, drainage tube removal and discharge from hospital were occurred at postoperative day 2, 3, 7 and 9, respectively. No anastomotic fistula, bleeding and infection were occurred after operation. The patient was diagnosed as with ulcerated sigmoid adenocarcinoma in T3N1cM1 stage (combining with liver metastasis). The patient received adjuvant therapy of mFOLFOX6 and oral capecitabine at postoperative day 40, and was followed up for 30 months with a good quality of life and without metastasis and recurrence. Conclusion Ⅰ-stage resection of colon cancer with synohronous liver metastasis can be used for initial unresectable colon cancer with liver metastasis after conversion therapy, and it is safe and feasible, with a good therapeutic effect. Key words: Colonic neoplasms, lower; Liver metastases, synchronous; Conversion therapy; One-stage resection; Laparoscopy

Two-stage hepatectomy and associated liver partition and portal vein ligation for staged hepatectomy (ALPPS) in treating liver metastases of rectal cancer: a case report

IntroductionAn innovative approach, called associated liver partition and portal vein ligation for staged hepatectomy(ALPPS), has made possible a marked increase in future liver remnant (FLR) volume over a short period of time, thus permitting extended hepatectomy.Case descriptionThis report describes ALPPS in a 63-year-old male patient with rectal cancer and synchronous multiple liver metastases. The primary lesion was resected, followed by chemotherapy. We had planned to completely resect the metastases in both liver lobes, but CT volumetry revealed a very small FLR (364 ml, 29% of the total liver volume, 0.61% of total body weight). His indocyanine green retention rate at 15 minutes was 12.7%. Because of the risk of tumor progression in the interim, we performed ALPPS. During the first stage, the tumor in segment 3 was resected, the right lobe was mobilized, the liver was partitioned, and the right portal vein was ligated. The right hepatic artery, duct and vein were secured with vessel loops. CT on postoperative day 6 showed sufficient FLR increase (from 364 ml to 573 ml, or from 0.61% to 0.96% of total body weight) and ICGR15 improvement to 3.4%. The second stage of ALPPS was on postoperative day 7, completing resection of the metastases. The patient recovered well and was discharged 21 days after the second step.Discussion and evaluationThe ALPPS approach has many advantages, but it lacks evidence of long-term results. Considering the high mortality and morbidity rates of ALPPS, it is essential to evaluate its risks and benefits in individual patients and determine the strict criteria for this surgical method.ConclusionsALPPS procedure rapidly increases FLR, permitting extended hepatectomy for patients with initially insufficient FLR.

切除不能大腸癌同時多発肝転移に対し全身化学療法施行後にliver first approachを行い，根治手術を施行しえた1例

切除不能大腸癌同時多発肝転移に対し全身化学療法施行後にliver first approachを行い，根治手術を施行しえた1例

A Case of Krukenberg Tumor Metastasized from Colon Cancer Subsequent to Synchronous Multiple Liver Metastasis

A Case of Krukenberg Tumor Metastasized from Colon Cancer Subsequent to Synchronous Multiple Liver Metastasis

同時性多発肝転移を伴ったS状結腸腺扁平上皮癌の１例

比較的稀な大腸腺扁平上皮癌の症例を経験したので，若干の文献的考察を加えて報告する． 症例は51歳，男性．血便，便秘を主訴に受診した．大腸内視鏡検査を施行し，２型のS状結腸癌を認め，生検の結果は高分化管状腺癌であった．精査の結果，S状結腸癌，多発性肝転移と診断した．S状結腸は主病巣による狭窄が強く通過障害を呈していたため，S状結腸切除術を施行した．病理組織診断では腺扁平上皮癌の診断であった．術後化学療法を施行したが，肝転移の増大を認め，術後35病日に癌死した．

One-stage surgical resection of 17 synchronous multiple bilobar liver metastasis from colorectal cancer: Case report and review of the literature

One-stage surgical resection of 17 synchronous multiple bilobar liver metastasis from colorectal cancer: Case report and review of the literature

術前FOLFOX6+Cetuximab療法が著効し根治手術を施行しえた直腸癌同時性多発肝転移の1例

術前FOLFOX6+Cetuximab療法が著効し根治手術を施行しえた直腸癌同時性多発肝転移の1例

Weekly docetaxel and cisplatin plus fluorouracil as a preoperative treatment for gastric cancer patients with synchronous multiple hepatic metastases: a pilot study

This pilot study was undertaken to assess the effect of weekly docetaxel, cisplatin and fluorouracil (DCF) as a preoperative treatment for gastric cancer with multiple synchronous hepatic metastases. Gastric cancer patients with synchronous multiple liver metastasis were first given preoperative chemotherapy consisting of two courses (each course consisted of 6-week administration and 2-week withdrawal) of weekly DCF regimen. Following the operation, postoperative chemotherapy and hepatic arterial infusion (HAI) treatment were performed as required. Eight patients completed two courses of preoperative chemotherapy with weekly DCF regimen. No toxicity of grade 3 or more was observed during the course of chemotherapy. The response rate was 100% according to the RECIST criteria. Seven of the patients have survived for over 1year, and six of them are still alive after more than 1year. Because of the unexpected high response to weekly DCF, we consider that it should be verified through phase II and III trials as an important part of the comprehensive treatment for gastric cancer with liver metastasis.

Analysis of a case with disappearance of the primary gastrointestinal stromal tumor and progressive liver metastases under long-term treatment with tyrosine kinase inhibitors

The response of gastrointestinal stromal tumors (GISTs) to tyrosine kinase receptor inhibitors (TKR-I) has been a breakthrough for small molecular therapy. We report here on the very different long-term outcome of a synchronous metastatic GIST with complete remission of the primary tumor and progressive liver metastases under TKR-I therapy. In 2003, a 52-year-old patient was diagnosed with gastric GIST and synchronous multiple liver metastases. Therapy with imatinib, 400 mg daily, was started immediately. Fifteen months later, the primary was no longer detectable by endoscopy. In 2006, progression of the liver metastases was observed. Mutation analysis of the initial biopsy specimen from the primary, as well as the biopsy from the three main liver metastases after 3 years of imatinib treatment, revealed the common KIT exon 11 deletion (W557_K558del) in all tumor samples. Two of the metastases had a separate secondary mutation in KIT exon 14 and 17, respectively, while the largest cystic metastatic lesion had no other mutation. Imatinib was then increased to a daily dose of 800 mg, and in April 2007 the treatment was changed to sunitinib. Fifty-two months after initial diagnosis, the patient died of liver failure. At no time point, relapse of the gastric primary tumor was observed. Whilst TKR-Is are commonly very effective in treating GISTs, the present case illustrates their varying effects regarding the clinical behavior and genetic variations within different tumors of the same patient after long-term treatment.

A case with synchronous multiple liver metastases from gastric carcinoma: postoperative long-term disease-free survival

We herein report a case with synchronous multiple liver metastases from gastric carcinoma surviving disease-free for more than 10 years after hepatic resection. A 64-year-old male admitted to our hospital because of constitutional wariness. Preoperative diagnosis was type 1 gastric cancer at the lower third of the stomach and multiple metastases of both hepatic lobes. After we performed distal gastrectomy with regional lymphadenectomy and wedge hepatic resection for eight metastatic liver tumors, he received 5-fluoropyrimidine and platinum-based adjuvant chemotherapy during the early postoperative period. The pathologic examination revealed moderately differentiated gastric adenocarcinoma with regional lymph node metastasis and multiple liver metastases. The postoperative course was uneventful and the patient is doing well without disease recurrence after more than 10 years following surgery. To the best of our knowledge, this patient is the longest disease-free survivor after liver resection for synchronous multiple liver metastases from advanced gastric cancer. In this modern era of developing liver surgery and adjuvant chemotherapy, combination therapy of aggressive surgery and early postoperative adjuvant chemotherapy for advanced gastric cancer with liver metastasis may allow long-term survival in selected patients.

Treatment of multiple liver metastasis from gastric carcinoma

BackgroundThe efficacy of operative resection of liver metastasis from colorectal cancer has been established. However, a treatment for liver metastasis from gastric cancer has not yet been established. In this study, we evaluated the efficacy of hepatic arterial infusion for synchronous hepatic metastasis from gastric cancer.Patients and methodsThis study consisted of 37 patients [HAI group; 18 and non-HAI group; 19] with synchronous multiple liver metastases from gastric cancer at Gunma Prefecture Saiseikai-Maebashi Hospital. We retrospectively analyzed the efficacy of HAI.ResultsResponse rate (CR + PR) of HAI was 83%. However, HAI treatment did not affect any improvement in the survival rate.ConclusionHAI is an effective treatment for control of liver metastasis specifically. The factor effective for an improvement in the survival rate was possibly that of gastrectomy.

Effect of Intra-Arterial Cisplatin on Multiple Liver Metastases from Rectal Cancer Associated with Ulcerative Colitis

We report a patient with synchronous multiple liver metastases from rectal cancer associated with ulcerative colitis. Because the liver tumors were unresectable, we performed total proctocolectomy and hepatic intra-arterial cisplatin infusion with systemic oral administration of fluorouracil. A complete response was obtained. The patient is alive without sign of recurrence 5 years postoperatively. Hepatic intra-arterial administration of cisplatin should be considered in the treatment of unresectable liver metastases from colorectal cancer.

A CASE OF RECTAL CANCER WITH LIVER METASTASES DIRECTLY INVADING THE STOMACH

A 60-year-old man was admitted to the hospital because of constipation in July, 1993. With a diagnosis of rectal cancer (Rs) with synchronous multiple liver metastases (H3), an abdominal resection of the rectum, a right hepatic lobectomy and partial liver resections of the segment 3 and 4 were performed. After while, partial liver resections were performed twice for recurrences in the segment 4 of the liver in June, 1994 and September, 1995. In September, 1997, a left lateral segmentectomy of the liver and a partial resection of the gastric wall were performed for recurrence in the residual liver which directly invaded the stomach. At that time, No. 6 lymph node metastasis was observed. Histologically, the surgical margin of the stomach was positive, and a distal gastrectomy with D1 lymph nodes dissection was carried out in October, 1997. It is rare that metastatic tumor directly invades the stomach. We report the patient who is surviving for 5 years after the initial operation with aggressive liver resection.