[A Case of Colorectal Cancer with Multiple Unresectable Liver Metastases That Achieved R0 after Chemotherapy and Laparoscopic Two-Stage Hepatectomy].

The patient was a 74-year-old man. He was referred to our institution due to bloody stool and multiple liver tumors. Close examination revealed primary colon cancer in the splenic flexure of the colon and multiple liver metastases(up to 6.5 cm, 16 in total)in both lobes of the liver, and he was finally diagnosed with transverse colon cancer(cT3N+M1a[H3], cStage Ⅳa). As the liver metastases were unresectable and the primary tumor was not stenosed, the patient was treated with chemotherapy. As RAS/BRAF mutation was negative, the chemotherapy with FOLFOX and panitumumab were administered. After 6 courses of chemotherapy, the primary and metastatic tumors were reduced had shrunk and CEA value had decreased. The liver metastases were concentrated in the right lobe of the liver, and radical resection was considered possible with right lobectomy and partial resection of the left lobe of the liver. As the residual liver fraction was expected to be 33%, one-stage hepatectomy was too risky and the two-stage hepatectomy was chosen. Laparoscopic left hemicolectomy and laparoscopic partial resection of the liver(S3 and S4, 4 tumor resections in total)were performed at the first operation. On postoperative day 8, the percutaneous transhepatic portal vein embolization(PTPE)of the right lobe of the liver was performed, and the expected residual liver fraction was increased to 40% 2 weeks after PTPE. The laparoscopic right lobectomy of the liver was performed on day 20 after PTPE. The patient has had no major complications or recurrences to date. We report a case in which R0 was achieved after aggressive chemotherapy and laparoscopic two-stage hepatectomy.