title: Downstaging and resection after neoadjuvant therapy for fibrolamellar hepatocellular carcinoma.
abstract: Fibrolamellar hepatocellular carcinoma (FLHCC) is a rare malignant liver neoplasm, commonly observed in adolescents and young adults of both genders. The disease is more common in Caucasians and in patients without a prior history of liver disease. The best treatment option is a surgical resection associated with liver hilum lymph node dissection. However, there is no established systemic drug treatment for patients with locally advanced or metastatic disease. We report on a patient with advanced FLHCC, initially considered unresectable due to invasion of the right and the middle hepatic veins and circumferential involvement of the left hepatic vein. Following the treatment with gemcitabine-oxaliplatin systemic chemotherapy, the patient exhibited a significant tumor reduction. As a result, a complete resection was performed with an extended right hepatectomy associated with a partial resection of the inferior vena cava, a wedge resection in segment 2, and lymphadenectomy of the hepatic hilum. The case was unusual due to the significant tumor downstaging with gemcitabine-oxaliplatin, potentially enabling curative resection. More studies are needed to confirm the efficacy of the systemic drug treatment for FLHCC.
authors: Gilton Marques Fonseca, Fabricio Ferreira Coelho, Emerson Shigueaki Abe, Rodrigo Blanco Dumarco, Paulo Herman, Digestive Surgery Division, Department of Gastroenterology, University of São Paulo School of Medicine, Avenida Doutor Enéas de Carvalho Aguiar 255, Instituto Central, 05403-900, São Paulo, Brazil.
authors: Gilton Marques
authors: GM
authors: Fonseca
authors: Gilton Marques Fonseca, Fabricio Ferreira Coelho, Emerson Shigueaki Abe, Rodrigo Blanco Dumarco, Paulo Herman, Digestive Surgery Division, Department of Gastroenterology, University of São Paulo School of Medicine, Avenida Doutor Enéas de Carvalho Aguiar 255, Instituto Central, 05403-900, São Paulo, Brazil.
authors: Antonio Drauzio
authors: AD
authors: Varella
authors: Gilton Marques Fonseca, Fabricio Ferreira Coelho, Emerson Shigueaki Abe, Rodrigo Blanco Dumarco, Paulo Herman, Digestive Surgery Division, Department of Gastroenterology, University of São Paulo School of Medicine, Avenida Doutor Enéas de Carvalho Aguiar 255, Instituto Central, 05403-900, São Paulo, Brazil.
authors: Fabricio Ferreira
authors: FF
authors: Coelho
authors: Gilton Marques Fonseca, Fabricio Ferreira Coelho, Emerson Shigueaki Abe, Rodrigo Blanco Dumarco, Paulo Herman, Digestive Surgery Division, Department of Gastroenterology, University of São Paulo School of Medicine, Avenida Doutor Enéas de Carvalho Aguiar 255, Instituto Central, 05403-900, São Paulo, Brazil.
authors: Emerson Shigueaki
authors: ES
authors: Abe
authors: Gilton Marques Fonseca, Fabricio Ferreira Coelho, Emerson Shigueaki Abe, Rodrigo Blanco Dumarco, Paulo Herman, Digestive Surgery Division, Department of Gastroenterology, University of São Paulo School of Medicine, Avenida Doutor Enéas de Carvalho Aguiar 255, Instituto Central, 05403-900, São Paulo, Brazil.
authors: Rodrigo Blanco
authors: RB
authors: Dumarco
authors: Gilton Marques Fonseca, Fabricio Ferreira Coelho, Emerson Shigueaki Abe, Rodrigo Blanco Dumarco, Paulo Herman, Digestive Surgery Division, Department of Gastroenterology, University of São Paulo School of Medicine, Avenida Doutor Enéas de Carvalho Aguiar 255, Instituto Central, 05403-900, São Paulo, Brazil.
authors: Paulo
authors: P
authors: Herman
keywords: Chemotherapy; Fibrolamellar hepatocellular carcinoma; Gemcitabine; Hepatectomy; Hepatic veins; Oxaliplatin