A Case of Arborecent Liver Necrosis following Continuous Arterial Infusion Chemotherapy after Resection for Liver Metastases of Alpha-Fetoprotein-producing Gastric Cancer

Abstract

A 61-year-old man underwent distal gastrectomy and partial hepatectomy September 30, 1998, for alphafetoprotein (AFP)-producing gastric cancer with liver metastasis (S4c+S8). Preoperative serum AFP was abnormally elevated at 5715 ng/ml. A catheter was placed in the common hepatic artery following the operation for continuous arterial chemotherapy to prevent residual liver recurrence. Epirubicin hydrochloride (20 mg on POD 20) and Fluorouracil (250mg/day, total of 40, 500mg) were infused. Nine months after the operation, an arborecent necrotic lesion resembling aseptic biloma due to tumor thrombi appeared in the right lobe, for which right hepatectomy was done July 8, 1999. Histlogical study showed liver necrosis caused by bile duct necrosis and bile leakage around Glisson's capsule. In this case, the inflammation due to bile leakage around Glisson's capsule because of continuous arterial infusion with 5-FU causes an arborecent liver necrosis and an occlusion of portal vein. He survived 2 year and 7 months without recurrence after the second operation.