Liver Metastasis Originating from Colorectal Cancer with Portal Vein Tumor Thrombosis: A Case Report and Review of the Literature

大腸直腸癌合併門靜脈腫瘤栓塞及肝轉移

林怡成(I-Chen Lin) ； 方川尹(Chuan-Yin Fang) ； 黃允中(Yun-Chung Huang) ； 戴元昌(Yuan-Chang Dai) ； 謝明芝(Ming-Chih Hsieh)

《中華民國大腸直腸外科醫學會雜誌》 25卷1期 (2014/03) Pp. 21-25

https://doi.org/10.6312/SCRSTW.2014.25(1).10304

摘要

大腸直腸癌合併肝轉移的患者中，有少數比例會有門靜脈腫瘤栓塞。我們報告一位76歲女性患者因升結腸癌接受腹腔鏡右半大腸切除術。術前檢查並無肝轉移情形，術後患者接受口服方式化學治療，在手術後5個月追蹤發現有門靜脈腫瘤栓塞情形，可能與大腸癌轉移有關。此時有建議患者更改化療方式或接受手術治療，但患者仍選擇繼續口服化療。於3個月後再次檢查，此時除了門靜脈腫瘤栓塞，同時合併多發性肝轉移，而患者也於數週後因肝衰竭死亡。

關鍵字

大腸直腸癌 ； 肝轉移 ； 門靜脈腫瘤栓塞

並列摘要

Purpose. Macroscopic tumor thrombi occupying the main portal branch are rarely seen in patients with liver metastasis and have only been reported in 2.8% of cases. We present a case of liver metastasis from colon cancer with a prominent tumor thrombus in the portal vein.Case Report. A76-year-old woman underwent a laparoscopic right hemicolectomy for adenocarcinoma of the ascending colon. The postoperative condition was initially satisfactory. Five months after the surgery, the patient was admitted to our hospital due to general fatigue. Magnetic resonance imaging (MRI) showed extensive filling defects over the entire portal vein. No definite metastatic nodules were observed in the liver parenchyma during imaging. The tumor marker levels were increased, and colon cancer with tumor thrombosis within the portal vein was highly suspected. We recommended the patient undergo systemic chemotherapy or surgical intervention; however, she refused. The patient was readmitted to our hospital 3 months later with poor appetite and malaise. Abdominal computed tomography (CT) delineated multiple liver metastases and progression of the tumor thrombosis over the portal vein. Unfortunately, the patient passed away a few weeks later due to sepsis with hepatic failure.Conclusions. There is no consensus on the treatment for colorectal liver metastasis accompanying portal vein tumor thrombosis; a better prognosis may be expected if the tumor can be completely resected en bloc. Multimodality treatments including surgery and adjuvant therapies should be performed to improve the survival rate.

並列關鍵字

Colorectal cancer ； Liver metastasis ； Portal vein tumor thrombosis (PVTT)