Cover Illustration: A Case of Sigmoid Colon Cancer with Synchronous Liver Metastasis
A 70-year-old man presenting with constipation was referred to our hospital. Colonoscopy revealed a circular Type II lesion in the sigmoid colon measuring 5.0 cm in size (Cover Illustration A) and a biopsy of the tumor proved well differentiated adenocarcinoma. Dynamic computed tomography scan also revealed a hepatic tumor, 8.8 cm in diameter, located in segment VI and VII of the liver, with slight enhancement of the circumference of the tumor in the delayed phase (Cover Illustration B). Serum CEA and CA19-9 values increased to 304 ng/ml and 347 IU/ml, respectively. A preoperative diagnosis of sigmoid colon cancer with solitary liver metastasis was made.
As the hepatic metastasis involved the root of the posterior portal branch, right hemihepatectomy was necessary to secure negative margin. To increase the safety of sigmoidectomy and hepatectomy, a two-staged operation was conducted; first, sigmoidectomy with D3 lymphadenectomy and transileocolic right portal vein embolization (TIPE), and second, right hemihepatectomy. Right TIPE for anterior portal branch (Figure C, arrow) decreased the volume of the right liver from 67 to 60% of total non-cancerous liver volume after an interval of 2 weeks. Right hemihepatectomy was performed 1 month after the first surgery and the post-operative courses were uneventful after both operations. Histological examination of the primary colon cancer revealed well to moderately differentiated adenocarcinoma with severe perineural invasion (Figure D). Metastatic tumor was diagnosed as well to moderately differentiated adenocarcinoma (Figure E).
(Hiroyoshi Ikeda and Hirokazu Taniguchi, National Cancer Center Hospital, Tokyo)
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