A Case of Colonic Liver Metastases with Macroscopic Intrabiliary Tumor Extension

Kenji Sakogawa, Koji Ohta, Minoru Tanada, Shinji Ohtani, Takaya Kobatake, Isao Nozaki, Kenjiro Aogi, Yoshiro Kubo, Akira Kurita and Shigemitu Takashima

Department of Gastroenterological Surgery, National Hospital Organization Shikoku Cancer Center

Macroscopic intrabiliary tumor growth in colonic liver metastasis warrants surgery whose favorable prognosis requires a significantly related clear resection margin, as indicated by the case we report here. A 65-year-old man undergoing right hemicolectomy with D3 lymph node dissection in pR0 in June 1998 for type 2 transverse colon cancer was diagnosed pathologically with moderately differentiated adenocarcinoma StageIIIb (ss, n₃ (+), P₀, H₀, M (-)). Follow-up found liver tumors with intrahepatic bile duct dilation twice metachronously-first in Couinaud nomenclature segment 6, 3 years after primary resection and second in segment 3, 4 years thereafter. Diagnostic imaging suggested that liver tumors were colonic metastasis. We conducted hepatic posterior segmentectomy first, followed by hepatic lateral segmentectomy, rather than partial hepatectomy to maintain a clear resection margin, both resulting in a negative tumor cell margin. Both resected specimens showed macroscopic intrabiliary tumor growth and the pathological diagnosis was moderately differentiated adenocarcinoma from colonic liver metastasis. The final diagnosis was colonic liver metastasis with macroscopic intrabiliary tumor growth.

Key words
intrabiliary extension, liver metastases, colon cancer

Reprint requests
Kenji Sakogawa Department of Surgery, Hiroshima Kyouritu Hospital, Hiroshima Medical Consumers Corporation
2-19-6 Nakasu, Asaminami-ku, Hiroshima, 731-0121 JAPAN

Accepted
May 19, 2010

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