A Case of Giant Hepatocellular Carcinoma Successfully Treated with Lenvatinib Followed by Parenchymal-Sparing Hepatectomy

Abstract

There have been few reports on use of molecular-targeted drugs as preoperative therapy for giant hepatocellular carcinoma that is difficult to resect. We report a case in which preoperative administration of lenvatinib in a patient with giant hepatocellular carcinoma resulted in tumor shrinkage and spared the remnant liver volume. The patient was a 78-year-old man with a 19-cm hepatocellular carcinoma protruding from segment (S) 5 and S6 of the liver, and intrahepatic metastasis in S8. The tumor was close to the posterior segmental branch of the portal vein. Extended posterior segmentectomy plus S8 partial resection (31.9% of the whole liver) was assumed to be required for curative resection. Since the ICG retention rate was 28.3% and there was a risk of early postoperative recurrence, we re-evaluated the patient after administration of lenvatinib. After six weeks of this treatment, the main tumor had shrunk in size and intrahepatic metastasis had disappeared. As a result, inferior segmental resection (10.7% of the whole liver) with a sufficient liver volume could be performed. This case suggests that lenvatinib may be a potential preoperative treatment option for giant hepatocellular carcinoma.