Treatment of “Unresectable” Bilobar Liver Metastasis Using a 2-Stage Approach and HAI: A Case Study

By Cristiano Quintini, MD

Presentation

A 42-year-old female was referred to our institution with large right colon cancer and synchronous bilobar liver metastasis (see presenting CT scan of the liver above). A particular challenge was presented by the lesion encasing the three hepatic veins of the liver (see arrows).

Treatment

The patient received three months of perioperative chemotherapy and was scheduled (three months after the initial presentation) for a two-stage hepatectomy and a combined resection of the primary right colon tumor.

The first surgery included a right hemicolectomy with resection of all the left-sided liver lesions. The surgery was uneventful. On postoperative day 6, the patient underwent a right portal vein embolization with the intent to induce hypotrophy of the right hemi liver and the hypertrophy of the left hemi liver. This approach is used to decrease the risks of postresection liver failure.

Six weeks after the first operation, the patient underwent a right hepatectomy. Given her young age and the extent of the disease, the decision was made to place to also place a hepatic artery infusion (HAI) pump to further decrease her likelihood of recurrence. HAI locoregional treatment is an innovative approach that improves survival after liver resection for metastatic colon cancer. This treatment option is only delivered in selected centers around the world.

The remnant left liver lobe with a catheter inside the gastro-duodenal artery for HAI treatment.

Outcome

One year after the initial presentation, the patient is free of tumor (see scan below) and receiving routine follow-up scans.

CT scan showing the patient free of tumor.