FIRST SYNCHRONOUS LIVER RESECTION AS A PART OF CYTOREDUCTIVE SURGERY, PERITONECTOMY AND HIPEC IN CROATIA – CASE REPORT
Autori:
Ana Majsec Budak, Mate Škegro, Mate Majerović, Dubravko Smuđ, Željko Jelinčić, Emil Kinda, Tihomir Kekez, Goran Augustin, Hrvoje Silovski, Petar Matošević, Tomislav Bruketa
Sažetak
Prikazujemo slučaj tridesetsedmogodišnje bolesnice s velikim adenokarcinomom poprečnoga debelog crijeva te metastazama u slezeni, jetri, peritoneumu, velikom omentumu, žučnome mjehuru, desnom jajniku i jajovodu. Nakon premještaja bolesnice u našu Bolnicu iz vanjske ustanove provedena je opsežna citoreduktivna kirurgija s multiorganskim resekcijama i hipertermijskom intraabdominalnom kemoterapijom (HIPEC). Nekoliko mjeseci kasnije ponovo je podvrgnuta kirurškom liječenju zbog novootkrivene metastaze u 7. jetrenom segmentu i ona je ukonjena. Kemoterapijske cikluse primala je tijekom cijeloga postoperativnog perioda. Danas, dvije godine nakon prve operacije, bolesnica je subjektivno bez tegoba i bez znakova recidiva bolesti. Agresivna citoreduktivna kirurgija koja uključuje multiorganske resekcije, peritonektomiju, HIPEC dokazano je primjenjiv način liječenja u određenih skupina bolesnika s uznapredovalim abdominalnim tumorima, u sklopu čega je i sinkrona resekcija jetre. Ovo je prva sinkrona resekcija jetre u sklopu redovito provođene citoreduktivne kirurgije i HIPEC-a u Hrvatskoj.
Summary
We present a case of a 37-year-old female, with large adenocarcinoma of transverse colon, and metastases in spleen, liver, peritoneum, greater omentum, gall bladder and right adnexa. She was transferred to our Hospital, and extensive elective cytoreductive surgery with intraabdominal hyperthermal chemotherapy (HIPEC) was performed. Couple of months later, she was operated on for a newly evidenced secondary nodus in liver segment VII, and metastasectomy was performed. Throughout entire postoperative period she was receiving cyclic chemotherapy. At this point, 2 years from the first operation, she was without evidenced recurrence of the disease. Aggressive cytoreductive surgery with multiorgan resection, peritonectomy, HIPEC and adjuvant chemotherapy which was proved to be a feasible option in some patients, with synchronous liver resection (LR) proved to be feasible and beneficial for patients with three or fewer liver metastases. This is the first liver resection included in usually performed cytoreductive surgery and HIPEC in Croatia.
