Right Hepatectomy (Réglée) for Liver Metastasis Post Pancreatic Adenocarcinoma – Case Report

Abstract

Background

Metastatic tumors of the liver are the most common hepatic malignant disease, responsible for more than 95% of the total. The size and number of metastases of the liver varies considerably. They maintain the anatomo-pathologic features of the primary cancer, but often are complicated by central necrosis. Pancreatic tumors often metastasize to the liver because of venous drainage to the portal vein. In cases of this occurrence, the disease is considered to be at stage IV with minimal to no consideration for a surgical approach despite the late improvements in liver resection and more efficient chemotherapy. There is a severely limited number of studies for patients undergoing liver resection for liver metastases that arise after a surgical treatment of pancreatic adenocarcinoma. However, these studies, which take in consideration the surgical liver resection versus chemotherapy alone in patients with metachronous metastases of pancreatic cancer demonstrate a significantly longer survival rate.

Case presentation

The 65 y/o male patient­­­­­­ was diagnosed one year prior to the current events with an adenocarcinoma of the pancreas tail, for which he underwent the surgical procedure of pancreatic tail resection and splenectomy. Ten months after the surgery he complains of fever and body temperature of 38 - 39°C. Despite taking antibiotics for over a month and a half he has no improvement. He is hospitalized in a febrile state, asthenic and pale skin and mucosa. Following an MRI the diagnosis leans towards a liver metastasis. A right réglée hepatectomy is performed. The patient tolerated the procedure well and was discharged in good health.

Discussion

Determining the amount of liver parenchyma to be removed is an important decision. Anatomic resections mostly include two or more hepatic segments, whereas non-anatomic resection involves the resection of the metastases with a margin of healthy tissue (segmentectomy). The decision concerning the extent of resection is more relevant for the post-operative chemotherapy in colorectal metastasis, where an effort is made to conserve as much as possible remnant liver tissue. A preoperative chemotherapy allows more patients to be considered resectable, but may damage hepatic function and increase the risk of post-operative liver insufficiency.

Conclusion

In conclusion, hepatic resection for metastatic non-colorectal non-neuroendocrine tumors is safe and is linked to better outcomes in chosen patients. However primary tumour type and disease-free intervals seem to be important variables. Sometimes, hepatic resection may be the only option offering a potential cure, so it should be considered in some patients with liver metastases of non-colorectal non-neuroendocrine tumors.

Keywords: General Surgery, Right Hepatectomy, Liver Metastasis, Pancreatic Adenocarcinoma.

DOI: 10.7176/JEP/14-9-07

Publication date:March 31^st 2023