title: [Long-term survival of a patient with metachronous lymph node metastasis and bile duct tumor thrombus due to hepatocellular carcinoma successfully treated with repeated surgery].
abstract: A 64-year-old man with hepatocellular carcinoma located in the left lateral lobe and segment 5 was referred to our hospital for surgical treatment. We performed left lateral sectionectomy and segmentectomy 5. The pathological diagnosis was moderately to poorly differentiated hepatocellular carcinoma, and the pathological stage was stage III. Eight months later, intrahepatic recurrence in segment 1 and lymph node metastasis in the hepatoduodenal ligament occurred. Partial resection of segment 1 was performed, and the metastatic lymph node was surgically removed. Twenty four months after the first operation, lymph node metastases along the lesser curvature and retropancreatic space were extirpated. Lymph node metastases along the common hepatic artery were removed 76 months after the first operation. The patient developed jaundice 88 months after the initial surgery, and the bile duct tumor thrombus derived from intrahepatic recurrence in segment 1 caused obstructive jaundice. After percutaneous transhepatic biliary drainage, we performed median sectionectomy and bile duct tumor thrombus removal without bile duct resection. At his 8-year follow-up visit after the primary operation, the patient was healthy and did not show any signs of recurrence. Lymph node metastasis and bile duct tumor thrombus are rare patterns of hepatocellular carcinoma recurrence, and aggressive surgery can result in long-term survival when complete resection is anticipated.
authors.affiliation: Dept. of Gastroenterological Surgery I, Hokkaido University Graduate School of Medicine.
authors.forename: Tatsuhiko
authors.initials: T
authors.lastname: Kakisaka
authors.forename: Toshiya
authors.initials: T
authors.lastname: Kamiyama
authors.forename: Hideki
authors.initials: H
authors.lastname: Yokoo
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Orimo
authors.forename: Kenji
authors.initials: K
authors.lastname: Wakayama
authors.forename: Yosuke
authors.initials: Y
authors.lastname: Tsuruga
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Kamachi
authors.forename: Kanako
authors.initials: K
authors.lastname: Hatanaka
authors.forename: Akinobu
authors.initials: A
authors.lastname: Taketomi
mesh_terms: D006528:Carcinoma, Hepatocellular / Q000601:surgery*; D006509:Hepatitis B / Q000150:complications; D006801:Humans; D041781:Jaundice, Obstructive / Q000209:etiology; D008113:Liver Neoplasms / Q000473:pathology / Q000601:surgery*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D012086:Reoperation; D013927:Thrombosis / Q000209:etiology / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome