A Case of Curative Resection of Advanced Rectal Cancer with Multiple Liver Metastases and Cancerous Ascites after Preoperative Chemotherapy

• Published in: Gan to kagaku ryoho Vol. 45; no. 13; p. 2193
• Main Authors: Mitsuhashi, Noboru, Shimizu, Yoshiaki, Mun, Yangi, Yoneura, Naoko, Sakai, Nozomu, Takano, Shigetsugu, Kuboki, Satoshi, Takayashiki, Tsukasa, Furukawa, Katsunori, Yoshitomi, Hideyuki, Ohtsuka, Masayuki
• Format: Journal Article
• Language: Japanese
• Published: Japan 01.12.2018
• ISSN: 0385-0684

The patient was a 59-year-old man who was hospitalized with diarrhea and general malaise. Massive ascites and systemic edema were observed upon initial physical examination. Blood test findings showed anemia, hepatic dysfunction, and increased tumor marker levels. Imaging examination revealed the presence of a primary tumor associated with stenosis, extending from the rectosigmoid junction to the upper rectum, multiple liver metastases, and massive ascites. Pathological examination indicated well-differentiated adenocarcinoma. A treatment strategy comprising colostomy and chemotherapy was implemented. Administration of 6 courses of mFOLFOX6 plus panitumumab(Pmab)and 4 courses of FOLFIRI plus Pmab led to marked shrinkage of the primary tumor and liver metastases and disappearance of the ascites. Chemotherapy was discontinued at the request of the patient. The patient developed melena after 2 years. Colonoscopy revealed enlargement of the rectal cancer, and surgical intervention was indicated. We adopted a treatment policy of 2-stage resection, and low anterior resection was performed. The liver was partially resected 3 months later. Hepatic recurrence was observed 9 months after the liver resection, and repeated resection of the liver was performed. An aggressive treatment approach can lead to improved prognosis even in cases involving multiple liver metastases and cancerous ascites.