Case Report
Hepatocellular carcinoma with duodenal invasion resected subsequent to multimodal therapies: A case report

https://doi.org/10.1016/j.ijscr.2019.06.046Get rights and content
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Highlights

  • Hepatocellular carcinoma (HCC) with duodenal invasion is a very rare occurrence.

  • Aggravated disease condition of HCC with duodenal invasion usually makes surgical treatment not advisable.

  • We present the first case of HCC with duodenal invasion resected following a multimodal therapy that included sorafenib.

  • Partial hepatectomy in conjunction with partial duodenectomy was selected to lessen surgical stress.

  • Surgical resection should be taken into consideration as a therapeutic choice even in progressive HCC disease condition.

Abstract

Introduction

Gastrointestinal (GI) involvement in hepatocellular carcinoma (HCC) is uncommon. In particular, HCC with duodenal invasion is known to be a rare condition. In such cases, surgical indication has been generally negative except in few reported cases. To our knowledge, this report describes the first case of HCC with duodenal invasion, resected by hepatectomy accompanied by pancreas-preserving partial duodenectomy (HPPD) following multimodal therapies including systemic sorafenib administration.

Case presentation

A 65-year-old man had been repeatedly treated for multiple HCCs by transarterial chemoembolization (TACE) and sorafenib. However, the main tumor formerly ruptured began to involve his duodenum, causing GI bleeding. The collateral vessels from the pancreatic and omental branches entered the tumor and nullified the transarterial hemostatic embolization. Hence, HPPD was performed to preserve the major Vater papilla. Histopathological examination revealed poorly-to -moderately differentiated HCC cells invading the duodenum.

Discussion and conclusion

HPPD treatment successfully removed HCC with duodenal invasion achieving viable tumor clearance status (R0). We underline the importance of achieving viable tumor clearance status at any time during the treatment course of patients with advanced HCC as this approach may be the only approach to enable HCC patients with duodenal invasion to resume a healthy life.

Abbreviations

HCC
hepatocellular carcinoma
TACE
transarterial chemoembolization
GI
gastrointestinal
HPPD
hepatectomy with pancreas-preserving partial duodenectomy
JSH
the Japan Society of Hepatology
BCLC
Barcelona Clinic Liver Cancer
PIVKA-2
protein induced by vitamin K absence or antagonist -Ⅱ
AFP
α-fetoprotein
HPD
hepatectomy with pancreaticoduodenectomy
DEB-TACE
drug-eluting beads-transarterial chemoembolization

Keywords

Hepatocellular carcinoma
Hepatectomy
Pancreas-preserving partial duodenectomy
Duodenal invasion
Sorafenib
Case report

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