A case of successful cure of rectal adenocarcinoma and synchronous multiple hepatic metastases with massive biliary tumor thrombi by two-stage surgery and systemic therapy

A 71-year-old female presented to our hospital with recent increase in diarrhea and body weight loss. Radiologic and endoscopic examinations revealed rectal adenocarcinoma with synchronous multiple liver metastases accompanied by widespread intrabiliary tumor thrombi. After primary tumor resection, systemic treatment using 5-fluorouracil, leucovorin, and oxaliplatin (FOLFOX), 5-fluorouracil, leucovorin, and irinotecan (FOLFIRI), and panitumumab was given. The disease responded well to treatment and about two years after rectal surgery she underwent left hemihepatectomy with removal of tumor thrombi. Histological examination showed that intrahepatic bile dusts were filled with tumor thrombi indicative of a tubular adenocarcinoma resembling rectal adenocarcinoma. No tumor invasion was observed on the surgical margins. She received 5-fluorouracil and leucovorin as adjuvant treatment for six months, and she has not shown any evidence of recurrence for one year after hepatectomy.