Hepatic metastasis from colorectal cancer, seven procedures and five recurrences, when to stop?

A Case report

Abstract

Introduction: Colorectal cancer commonly metastasizes to the liver. Patients treated by metastasectomy gain a longer overall survival and progression-free survival than those patients treated by radiofrequency ablation.  Case presentation: This paper reports the case of a 58-year-old male who presented with constipation, bleeding per rectum and weight loss. Colonoscopy showed rectosigmoid mass, and an MRI of the abdomen and pelvis revealed that there was a circumferential polypoidal rectal soft tissue mass involving the upper half of the rectum extending approximately 8 cm in the longitudinal length to the retro-sigmoid junction and 9 cm from the anal verge. It showed local extension to the mesorectal fat with significant invasion to the mesorectal fascia anteriorly. The lesion did not extend to the scrotum, prostate or urinary bladder. Multiple mesorectal lymph node and multiple foci lesions were seen in the liver, suggesting metastasis. The patient was staged as T3N2M1. After that, lower anterior resection with diversion ileostomy and intraoperative radiofrequency ablation of segment IVa and resection of IVb segment was done. From 2013 to 2017 the patient had multiple procedures: right hepatectomy, resection of segment II and IVA, alcohol ablation of segment II, microwave ablation through US guided for segment II and wedge resection in segment IV respectively. Six weeks later, the patient was looking well with normal liver function tests. Resection offers the greatest possibility of cure for patients with liver-isolated colorectal cancers, with 5-year survival rates of 25-58%.  Take-away lesson: The overall clinical importance of this case report is to show how repeated liver resection improves the quality of life.