RESUMEN
Patients with advanced hepatocellular carcinoma (HCC) showing portal vein tumor thrombosis (PVTT) have an extremely poor prognosis. According to treatment guidelines, the only option for HCC patients with PVTT is sorafenib chemotherapy. However, in Asia, various treatments have been attempted and possible prolongation of overall survival has been repeatedly reported. We herein report the first case of a patient with an initially unresectable advanced HCC with PVTT who underwent curative hepatectomy after sorafenib and transcatheter arterial chemoembolization (TACE) showing complete histological response. Two months after induction with sorafenib, a significant decrease in serum alpha-fetoprotein level was observed and computed tomography imaging showed a significant decrease in tumor size. Because of remaining PVTT, TACE and curative resection were performed. The combination of sorafenib and TACE may be an effective treatment for HCC patients with PVTT.
Asunto(s)
Antineoplásicos/uso terapéutico , Carcinoma Hepatocelular/terapia , Quimioembolización Terapéutica , Neoplasias Hepáticas/terapia , Niacinamida/análogos & derivados , Compuestos de Fenilurea/uso terapéutico , Inhibidores de Proteínas Quinasas/uso terapéutico , Anciano , Angiografía de Substracción Digital , Carcinoma Hepatocelular/complicaciones , Carcinoma Hepatocelular/diagnóstico por imagen , Carcinoma Hepatocelular/patología , Hepatectomía , Humanos , Neoplasias Hepáticas/complicaciones , Neoplasias Hepáticas/diagnóstico por imagen , Neoplasias Hepáticas/patología , Masculino , Niacinamida/uso terapéutico , Flebografía/métodos , Vena Porta/diagnóstico por imagen , Sorafenib , Factores de Tiempo , Tomografía Computarizada por Rayos X , Resultado del Tratamiento , Trombosis de la Vena/diagnóstico por imagen , Trombosis de la Vena/etiología , Trombosis de la Vena/terapiaRESUMEN
A 65-year-old man with bloody stools was diagnosed with sigmoid colon cancer on colonoscopy. A preoperative barium enema and a computed tomography colonography scan showed a medial displacement of his descending colon. The preoperative clinical diagnosis was stage cT1 colon cancer, N0, M0, cStage I . Laparoscopic sigmoidectomy was performed. We found adhesions between the descending colon mesentery and the pelvic wall, and noted that the descending colon was not fused with the retroperitoneum and was shifted to the midline. The patient was diagnosed with persistent descending mesocolon (PDM). PDM is a congenital anomaly of fixation resulting from the failure of the descending colon mesentery to fuse with the parietal peritoneum. Anatomical findings should have been noted during the operation, including the fact that the descending colon artery, sigmoid colon artery, and superior rectal artery often branch radially from the inferior mesenteric artery. It is important to understand the anatomical characteristics of PDM and to improve on existing surgical procedures to ensure safe laparoscopic surgery for these patients.