[A Case of Simultaneous Resection of Single Lung and Liver Metastases with Combined Immunotherapy after Radical Surgery for Hepatocellular Carcinoma].

The patient is a 66-year-old man. He underwent posterior and antero-dorsal segmentectomy for hepatocellular carcinoma(HCC)detected at physical examination. Early postoperatively, he developed a single S3 metastasis in the left lung and started combination therapy with atezolizumab plus bevacizumab. During the ninth course of treatment, recurrence was also observed in S2 of the remaining liver. A partial resection of the left upper lobe of the left lung was performed by open thoracotomy and partial resection of the outer hepatic segment through a diaphragmatic approach. Histopathological analysis suggested that the lung metastasis was distant metastasis from the first posterior segment tumor and that the liver S2 was multicentric carcinoma. He was treated with lenvatinib for a short period of time postoperatively, but recurred multiple metastases in both lungs on CT scan 3 months later. He has been treated with a combination of durvalumab plus tremelimumab while submitting to cancer genome testing, which revealed TMB-high and MSI-high. Tissue sampling is essential for the diagnosis of inter-hepatic metastasis or multicentric occurrence, and in the case of ipsilateral hepatopulmonary metastasis, trans-diaphragmatic approach surgery is effective for less incision surgery. Combined immunoadjuvant therapy for resected HCC has shown efficacy in short-term results.