Treatment of Caudate Lobe Metastasis Post Colon Cancer Surgery – Case Report

Abstract

Background

Colorectal carcinoma is the third cause of mortality from malignant cancers. Upon diagnosis about 1 in 5 patients have metastatic disease. Furthermore, patients with local disease will on average have an incidence of 25% for distant metastases. Most common locations of CRC metastases are the liver, lungs, peritoneum and lymph nodes in distance. The diagnosis of metastatic disease in colorectal cancer should always be confirmed before any surgical or systemic treatment via adequate histological and imaging methods. Biochemical tests for carcinoembryonic antigen, CEA and carbohydrate antigen, CA19-9 are strongly advised. For the accurate staging of the disease IV contrast enhanced Computed Tomography is recommended, whereas MRI is useful in detection of exact number and location of liver metastases. Surgical treatment options may vary depending on the stage, locoregional involvement of the primary disease and the resectability of metastatic disease. It is a topic of ongoing investigation; however, guidelines recommend R0 surgical resection where possible as it may be potentially curative in 20-45% of cases.

Case presentation

We present the case of a 62 years old patient diagnosed with a right colon cancer and a solitary metastasis of the Ist segment of liver. He underwent the surgical procedure of right hemicolectomy and followed a course of 6 chemotherapy cycles. After an abdominal CT with IV contrast and abdominal MRI, a solitary caudate lobe metastasis is confirmed. A joint staff of oncologists, gastroenterologists and surgeons it is decided for a surgical intervention. He underwent the surgical procedure of the resection of liver metastasis in the caudate lobe. He tolerated the procedure well and was discharged in good health.

Discussion

In patients where metastases can be safely resected from the technical aspect, surgery is recommended. In cases where clear margins are difficult to achieve or patient prognosis is unclear, perioperative chemotherapy is mandatory, with FOLFOX or CAPOX regimens. In patients potentially curable with conversion therapy it is required to consider the molecular profile and tumor location. After starting conversion therapies patients should be evaluated periodically to avoid overtreatment. If surgery is feasible, metastases should be resected completely, maintaining at least 30% liver remnant.

Conclusion

Patient outcomes improve significantly when individual cases of metastatic colorectal disease are discussed between a team of oncologists, surgeons, radiologists, radiotherapists and other experts. We advise regular consultations of multidisciplinary teams to ensure the best therapeutic strategy. In conclusion, colorectal carcinoma is a complex disease, for which a therapeutic algorithm should be initially chosen and adhered to, by the multidisciplinary team to ensure the continuum of care.

Keywords: General Surgery, Colon Cancer, Liver Metastasis, Caudate Lobe Resection, I-st Segment Liver.

DOI: 10.7176/JEP/14-29-01

Publication date:October 31^st 2023