title: Successful en bloc resection of primary hepatocellular carcinoma directly invading the stomach and pancreas.
abstract: Multivisceral surgical resection for cure was successfully performed in a 70-year-old man suffering from a primary hepatocellular carcinoma (HCC) associated with direct invasion to the stomach and pancreas. The patient presented with gastric outlet obstruction, upper abdominal pain and a history of chronic liver disease due to hepatitis B virus (HBV) infection. Upper gastrointestinal (GI) endoscopy revealed an infiltrating tumor protruding through the gastric wall and obliterating the lumen. Computer tomograghy (CT) and magnetic resonance imaging (MRI) scan demonstrated a 15-cm tumor in the left lateral segment of the liver with invasion to the stomach and pancreas. Alpha-foetoprotein (AFP) levels and liver function tests were normal. The patient underwent an en bloc left hepatectomy, total gastrectomy, distal pancreatectomy with splenectomy and radical lymphadenectomy. Pathology revealed a poorly differentiated, giant cell HCC involving the stomach and pancreas. Disease-free margins of resection were achieved. The patient's postoperative course was uneventful. Sixteen months after surgery, he has no recurrence or distal metastasis. Direct invasion of HCC into the GI tract is rarely encountered. Complete surgical resection should be considered in selected patients with an appropriate hepatic functional reserve.
authors.affiliation: Department of Surgical Oncology, Hellenic Anticancer Institute, Saint Savvas Hospital, 22 Socratous Street, 1st Floor, Kifissia, Athens 14561, Greece. dkorkolis_2000@yahoo.com
authors.forename: Dimitris P
authors.initials: DP
authors.lastname: Korkolis
authors.forename: Chrysanthi
authors.initials: C
authors.lastname: Aggeli
authors.forename: George D
authors.initials: GD
authors.lastname: Plataniotis
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Gontikakis
authors.forename: Helen
authors.initials: H
authors.lastname: Zerbinis
authors.forename: Nikitas
authors.initials: N
authors.lastname: Papantoniou
authors.forename: Dimitris
authors.initials: D
authors.lastname: Xinopoulos
authors.forename: Nikiforos
authors.initials: N
authors.lastname: Apostolikas
authors.forename: Perikles P
authors.initials: PP
authors.lastname: Vassilopoulos
mesh_terms: D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000473:pathology*; D004724:Endoscopy; D005743:Gastrectomy; D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000473:pathology* / Q000601:surgery*; D008875:Middle Aged; D009361:Neoplasm Invasiveness / Q000473:pathology; D010180:Pancreatectomy; D010190:Pancreatic Neoplasms / Q000473:pathology* / Q000601:surgery*; D013274:Stomach Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome