Complete Response of Residual Liver Lesions After Primary Aggressive Surgical Therapy Followed by Chemotherapy in Initially Unresectable Extensive Synchronous Colorectal Liver Metastasis: A Case Report and Literature Review

BACKGROUND: Liver surgery is considered as a beneficial approach to increase survival rates in patients with colon cancer hepatic metastases. A hepatobiliary multidisciplinary board must evaluate patients with synchronic CRLM, because early multimodal management of patients with potentially resectable CRLM is fundamental for overall survival.
CASE REPORT: Here, we demonstrate the case of a young man with very advanced sigmoid carcinoma and widespread hepatic metastases affecting the whole liver. He underwent extended right hepatectomy with partial right diaphragm resection and standard left hemicolectomy. Margins of a resected specimen were all tumor-free. Some of the dissected lymph nodes from the left hemicolectomy were tumor-positive. At the end of the operation, the remnant liver still contained about 10 lesions of various diameters. The surgical course was ordinary. After the extensive surgery, postoperative systemic chemotherapy was given. The multidisciplinary team approved this approach.
The remaining lesions disappeared and 3 calcifications became visible after 6 courses of chemotherapy. CEA decreased from 1800 µg/l (preoperative) to a normal value below 3.5 µg/l.
CONCLUSIONS: This individualized and personalized multidisciplinary approach could be advantageous and efficacious in highly selected young patients. Further studies are essential.

Keywords: Antineoplastic Combined Chemotherapy Protocols, Liver Neoplasms