Authors: Yutaro Kato Kentaro Matsubara Yoshinobu Akiyama Hiroaki Hattori Akira Hirata Tatsuya Yamamoto Fumio Suzuki Hitoshi Ohtaka Yoshiaki Sugiura Masaki Kitajima
Publish Date: 2010/10/21
Volume: 16, Issue: 4, Pages: 421-427
Abstract
A rare resected case of hepatocellular carcinoma HCC invading the duodenum the common bile duct CBD the gallbladder and the pancreas is described A 63yearold man presented with a painful upper abdominal mass Radiologic findings showed a 25cm liver tumor arising from segment IV with an invasive extension to the hepatoduodenal ligament and pancreatoduodenal region with a single intrahepatic metastasis The patient successfully underwent a left hepatectomy in conjunction with a pyloruspreserving pancreatoduodenectomy PD As an unusual procedure liver parenchymal transection was followed by PD to explore tumor resectability because the overhanging liver mass precluded full hepatoduodenal ligament dissection He was discharged without surgical complications being free from antianalgesics which had been used preoperatively The main tumor was histologically diagnosed to be a poorly differentiated HCC with sarcomatous change invading the duodenum the CBD the gallbladder and the pancreas Unfortunately aggressive hepatic and nodal recurrence which was resistant to salvage chemotherapy caused the patient’s death at 8 months postoperatively This is the first documented case of HCC with biliopancreatoduodenal invasion resected by hepatopancreatoduodenectomy Literature review suggests a significant role of resection in selected patients with HCC with contiguous gastrointestinal tract invasion particularly when the HCCs are naive without any forms of previous treatment However further surgical and nonsurgical experience is necessary to determine the oncological validity of aggressive surgery for HCC invading the biliopancreatoduodenal region
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