title: Treatment of colorectal liver metastasis with biliary and portal vein tumor thrombi by hepatopancreatoduodenectomy.
abstract: We present a case of a large colorectal liver metastasis with portal vein and biliary tumor thrombi and duodenal and jejunal direct invasion that required hepatopancreatoduodenectomy. A 38-year-old woman presented to her local hospital with right back pain and jaundice. She had undergone transverse colectomy and limited liver resection for transverse colon cancer with a synchronous liver metastasis in September 1991, and low anterior resection for rectal carcinoma in January 1996. She was diagnosed as having colorectal liver metastasis and was referred to our hospital for possible surgery. Radiologic and endoscopic examinations revealed a large liver tumor occupying the right lobe, biliary dilation in the left lateral section, and a portal vein tumor thrombus. Invasion of the inferior vena cava and the right renal vein were also suspected. Intraoperative findings revealed a large liver tumor that occupied the right lobe and invaded the duodenum and jejunum. The tumor was resected successfully by right trisectionectomy, caudate lobectomy, pancreatoduodenectomy, partial resection of the jejunum, and combined portal vein resection and reconstruction. The inferior vena cava, right kidney, and renal vein could be detached from the tumor. The patient has enjoyed an active life without recurrence for 2 years since the operation.
authors.affiliation: Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan.
authors.forename: Teiichi
authors.initials: T
authors.lastname: Sugiura
authors.forename: Masato
authors.initials: M
authors.lastname: Nagino
authors.forename: Tomoki
authors.initials: T
authors.lastname: Ebata
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Arai
authors.forename: Koji
authors.initials: K
authors.lastname: Oda
authors.forename: Norihiro
authors.initials: N
authors.lastname: Yuasa
authors.forename: Yuji
authors.initials: Y
authors.lastname: Nimura
mesh_terms: D000328:Adult; D001659:Biliary Tract; D015179:Colorectal Neoplasms / Q000473:pathology*; D004379:Duodenal Neoplasms / Q000175:diagnosis / Q000601:surgery; D005260:Female; D006498:Hepatectomy; D006801:Humans; D007580:Jejunal Neoplasms / Q000175:diagnosis / Q000601:surgery; D010535:Laparoscopy; D008113:Liver Neoplasms / Q000175:diagnosis / Q000556:secondary* / Q000601:surgery*; D009361:Neoplasm Invasiveness; D009360:Neoplastic Cells, Circulating; D016577:Pancreaticoduodenectomy; D011169:Portal Vein / Q000601:surgery