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Case Report

Resection of hepatocellular carcinoma after combined
Resection of hepatocellular carcinoma after combined
treatment with transarterial chemoembolization and sorafenib:
treatment with transarterial chemoembolization and sorafenib:
a case report and literature review
a case report and literature review

Kenneth Siu Ho Chok, Ian Yu Hong Wong, See Ching Chan, Ronnie Tung Ping Poon,
Chung Mau Lo
Department of Surgery, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China

ABSTRACT
Hepatocellular carcinoma (HCC) with inferior vena cava (IVC) invasion and metastatic lymph node metastases has a poor
prognosis, and surgical resection is seldom indicated. We report how an initially unresectable HCC in a 36-year-old Chinese
male with distant lymph node metastases and tumor thrombosis in the IVC was successfully downstaged and ultimately resected
together with the IVC. After the disease had been downstaged, curative resection of the tumor and IVC was conducted with
immediate reconstruction of the IVC. The patient has survived for more than 2 years after the surgery. In conclusion, tumor and
IVC resection can cure metastatic HCC after downstaging treatment combining sorafenib and transarterial chemoembolization.

Key words: Downstaging; hepatocellular carcinoma; lymph node metastases; sorafenib; vascular resection

Address for correspondence:
Dr. Kenneth Siu Ho Chok, Department of Surgery, Queen Mary Hospital, The University of Hong Kong, 102 Pok Fu Lam Road, Hong Kong, China.
E-mail: kennethchok@gmail.com
Received: 04-02-2015, Accepted: 25-03-2015

INTRODUCTION and his alpha-fetoprotein (AFP) level was markedly high at
8,195 ng/mL. Computed tomography (CT) conducted in July 2011
There have been a few studies documenting the survival benefits showed a 9.7-cm HCC in his right liver lobe, with direct invasion
of treating unresectable hepatocellular carcinoma (HCC) with of the retrohepatic inferior vena cava (IVC). There was also an
sorafenib, [1,2] but randomized trial documenting the efficacy evidence of lymphadenopathy at the porta hepatis and in the
of sorafenib as a neoadjuvant therapy is lacking. Sorafenib para-aortic region. In view of the extrahepatic involvement, HCC
impedes angiogenesis and induces apoptosis with efficacy, [3,4] was considered unresectable. The patient was put on sorafenib
whereas transarterial chemoembolization (TACE) is a potent (400 mg, twice a day) and entecavir. He developed tolerable Grade
stimulator for angiogenesis. Theoretically, the combination 2 adverse drug reaction (diarrhea and hand-foot syndrome).
[5]
of sorafenib and TACE should has a synergistic effect.
One dose of TACE was given in August 2011. Reassessment
CASE REPORT CT in October 2011 showed interval decrease in the size
of the tumor to 5.9 cm, but there were still lymph node
A 36-year-old Chinese male had painful hepatomegaly for metastases and tumor thrombus in the IVC. His AFP level had
2 weeks. He was tested positive for hepatitis B surface antigens dramatically lowered to 50 ng/mL. The tumor further reduced
in size on subsequent CT in February 2012; however, the AFP
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Quick Response Code level slowly rebounded to 430 ng/mL. Two more sessions of
Website: TACE were given in April and July 2012 [Table 1]. Whole-body
11
http://www.hrjournal.net/ dual-tracer ( C-acetate and 18F-fluorodeoxyglucose) positron
emission tomography and CT performed in September 2012
DOI: confirmed resolution of metastatic lymphadenopathy, but
10.4103/2394-5079.155694 IVC tumor thrombus and the adrenal invasion were still
hypermetabolic [Figure 1].

104 Hepatoma Research | Volume 1 | Issue 2 | July 15, 2015