ObjectiveTo explore the curative effect of synchronous resection of hepatopancreas lesions in the treatment of hepatic oligometastatic pancreatic cancer. MethodsThe patients with hepatic oligometastatic pancreatic cancer who met the inclusion and exclusion criteria in the Neijiang Second People’s Hospital from January 2016 to December 2020 were retrospectively collected. The enrolled patients were divided into resection group and non-resection group according to the treatment method. The patients in the resection group were treated with synchronous resection of hepatopancreas lesions, the patients in the non-resection group were treated with conservative treatment including palliative bypass surgery, biliary drainage, systemic chemotherapy, and so on. The patients were followed up to December 2021. The overall survival of the patients in the two groups were compared, and the factors affecting the overall survival were analyzed. ResultsA total of 54 patients who met the inclusion and exclusion criteria were collected in this study, including 31 cases in the resection group and 23 cases in the non-resection group. There were no statistical differences between the two groups in the baseline data such as age, gender, preoperative liver function indexes, and so on (P>0.05). The pancreaticojejunostomy leakage occurred in 7 cases (22.6%) of the resection group. The median follow-up time of the resection group and the non-resection group were 14 and 11 months. The median overall survival time of patients in the resection group and non-resection group were 18.0 months [95%CI (13.8, 22.1)] and 12.0 months [95%CI (8.2, 15.8)] respectively. The survival of the resection group was better than that of the non-resection group by log-rank test (χ2=4.074, P=0.045). Cox multivariate regression analysis result showed that the preoperative low albumin level (≤35.0 g/L), no perioperative chemotherapy, and no synchronous resection of hepatopancreas lesions shortened the overall survival time of patients with hepatic oligometastatic pancreatic cancer (P<0.05). For the patients who underwent the synchronous resection of hepatopancreas lesions, R0 resection and perioperative chemotherapy could prolong the overall survival time (P<0.05). ConclusionsFrom the results of this study, synchronous resection of hepatopancreas lesions can benefit survival for patients with hepatic oligometastatic pancreatic cancer. The prognosis of patients without R0 resection and perioperative chemotherapy is even worse.
Objective
To develop tailored treatment regimens for a patient with simultaneous liver metastasis of rectal cancer.
Methods
Considering the patient's specific condition of different teatment stage, the specialists of oncology, imaging, gastroenterology, hepatic surgery, and radiotherapy conduct multidisciplinary consultation.
Results
After hepatic metastatic tumor was resected, 4 cycles of XELOX chemotherapy combined with radiotherapy, tumor recurrence did not found in the liver. After resection of rectal cancer, the patient received 6 cycles of XELOX. The CEA and the thoracic, abdominal CT and pelvic MRI were reviewed 9 months after operation and no recurrence of the tumor was found.
Conclusion
The MDT mechanism can provide individualized treatment for patients with advanced rectal cancer and benefit these patients.
Objective
To summarize the treatment and prognosis of malignant tumors with hepatic metastasis.
Methods
Review and analysis of recent relevant literatures at home and abroad of malignant tumors with liver metastasis, according to the different treatments were summarized. Evaluation of the patients’ clinically curative effect and survival situation was performed under different treatments.
Results
With the development of imaging and surgical techniques, and deeply understanding of malignant tumor, many malignant tumors with liver metastasis could be found and treated, and previous concept of treatment for malignant tumors with liver metastasis was also fundamentally changed, and radical resection of the primary lesions and liver metastasis was the best way to get clinically curative effect for the patients with malignant tumors with liver metastasis. The treatments of malignant tumors with liver metastasis also included radio frequency ablation (RFA), transarterial chemoembolization (TACE), chemotherapy,125I seed implantation, cryotherapy, stereotactic body radiation therapy (SBRT), laser-induced interstitial thermotherapy (LITT), gene targeting therapy, and so on.
Conclusion
Now for malignant tumors with liver metastasis, positive surgery and (or) individualized comprehensive treatment are taken more often, and they play positive role to prolong the survival and improve the prognosis of malignant tumors patients with liver metastasis.
ObjectiveTo summarize the experience of combined treatment of conventional transcatheter arterial chemoembolization (cTACE) and drug-eluting-bead chemoembolization(D-TACE) in a case of advanced hepatocellular carcinoma with intrahepatic metastasis.MethodsA patient with advanced hepatocellular carcinoma who was admitted to The Second Affiliated Hospital of Chongqing Medical University in October 2018 was treated with TACE for three times.ResultsAfter MDT discussion, three interventional operations were performed on this patient in The Second Affiliated Hospital of Chongqing Medical University. CT examination after the first treatment with cTACE showed that lipiodol deposited in liver lesions and the lesions were more stable than before; after the second treatment with cTACE and D-TACE, CT examination showed more lipiodol deposited in the tumors, and the tumors were more limited and significantly reduced; after the third treatment with cTACE, CT examination showed that the tumors were effectively controlled and no progress was made. This patient was followed-up for 2 months after the fourth cTACE, tumors were effectively controlled and no progress occurred.ConclusionsIn advanced hepatocellular carcinoma with intrahepatic metastasis, TACE is the best treatment. Combination of D-TACE and cTACE can achieve better clinical efficacy.
Extrahepatic metastasis in hepatocellular carcinoma indicates that the disease has progressed from a liver-confined lesion to an advanced systemic stage, representing an important clinical condition that influences therapeutic decision-making and patient prognosis. These patients are often characterized by a complex background of chronic liver disease, impaired hepatic functional reserve, variable intrahepatic primary tumor burden, and substantial heterogeneity in the site, extent, and burden of extrahepatic metastases, resulting in marked variability in disease status and therapeutic needs and substantial complexity in clinical decision-making. In recent years, with the rapid development of systemic therapies for advanced hepatocellular carcinoma and the continuous refinement of local and locoregional approaches, including surgery, interventional therapy, ablation, and radiotherapy, the treatment paradigm for this population has gradually shifted from single-discipline decision-making to comprehensive multidisciplinary management. In clinical practice, the management of patients with hepatocellular carcinoma and extrahepatic metastases requires not only evaluation of intrahepatic tumor status, hepatic functional reserve, and the underlying liver disease, but also assessment of the location, extent, symptom burden, and risk of organ dysfunction related to extrahepatic lesions. These factors should be integrated with the patient’s general condition and tolerance to subsequent treatment in order to formulate a stage-specific and goal-directed management strategy. The Chinese Expert Consensus on the Multidisciplinary Diagnosis and Management of Hepatocellular Carcinoma with Extrahepatic Metastases（2026 Edition) systematically addresses key issues including multidisciplinary collaborative assessment and decision-making pathways, imaging evaluation, systemic therapy, and the integration of local treatment. It also provides organ-specific recommendations based on the clinical characteristics of metastases involving the lung, bone, lymph nodes, adrenal glands, peritoneum, and brain, with the aim of providing a reference for standardized multidisciplinary management of patients with hepatocellular carcinoma and extrahepatic metastases.
