A case of long term survival after two surgical resections of hepatocellular carcinoma with peritoneal dissemination

Abstract

The patient was a 65-year-old male who had a hepatic resection of S6 for hepatocellular carcinoma. Abdominal CT performed 14 months later revealed a round tumor of 2 cm diameter at the hepatic flexure of the colon and a diagnosis of peritoneal dissemination of the cancer was made. Laparotomy was performed to remove the intra-peritoneal mass. Pathological diagnosis was dissemination of the hepatoccellular carcinoma. During the follow up at out patient clinic multiple intra-hepatic recurrence of cancer was found and TAEs (transcatheter arterial embolization) were performed twice. When the patient was readmitted for the insertion of a reservoir for intra-arterial infusion of chemotherapy, tumors of 3 cm sizes were found on the right side of the ascending colon and in the Douglas pouch and a laparotomy was performed again. Pathological diagnosis of the specimen was hepatocellular carcinoma. Intra-hepatic arterial administrations of chemotherapy were repeated for the intra-hepatic recurrences with good control of the cancer. The second removal of the disseminated tumors two years after the first recurrence of the dissemination was performed. The edge the resected specimen was free of cancer and no distant metastasis of the cancer was found with good general condition of the patient. This experience indicated a possible favorable long term result with satisfactory QOL of the patient even in case of intra-peritoneal dissemination of hepatocellular carcinoma by the management with control of the original cancer, chemotherapy and local surgical resection of the intra-peritoneally disseminated tumors.