摘要
BACKGROUND Hepatocellular carcinoma(HCC)with massive portal vein tumor thrombosis(PVTT)and distant metastasis is considered unresectable.However,due to recent developments in systemic chemotherapy,successful cases of conversion therapy for unresectable diseases have been reported.Herein,we report a successful multidisciplinary approach for treatment of multi-visceral recurrence with sequential multikinase inhibitor and laparoscopic surgery.CASE SUMMARY A 63-year-old woman with chronic hepatitis B virus infection was diagnosed with HCC.Subsequently,she underwent two rounds of laparoscopic partial hepatectomy,laparoscopic left adrenalectomy,and transcatheter arterial chemoembolization plus sorafenib for recurrence.Four years after initial hepatectomy,she presented with a 43-mm mass in the spleen and tumor thrombus involving the main portal vein trunk with ascites.Her liver function was Child-Pugh B(8),and protein induced by vitamin K absence or antagonist II(PIVKA II)levels were elevated up to 46.291 mAU/mL.Since initial treatment with regorafenib for three months was unsuccessful,the patient was administered lenvatinib.Ten months post-treatment,there was no contrast enhancement of PVTT or splenic metastasis.Chemotherapy was discontinued due to severe diarrhea.Afterward,splenic metastasis became viable,and PIVKA II increased.Therefore,hand-assisted laparoscopic splenectomy was performed.She experienced no clinical recurrence 14 mo after resection.CONCLUSION Conversion surgery after successful multikinase inhibitor treatment might be considered an effective treatment option for advanced HCC.
