A 58-year-old male patient with advanced HCC and untreated
hepatitis B was referred to our hospital. The
tumor at the right lobe was 10 cm in diameter with right portal vein
thrombus. Because of the possible lung
metastasis and concern about the remaining hepatic function after extended right
hepatectomy,
lenvatinib was initiated before surgery. After the confirmation of a sharp decrease of
tumor markers during the 3-week
lenvatinib therapy, only a right portal vein transection was done leaving the enlargement of the left lobe for improved post-
hepatectomy liver function while
lenvatinib therapy was continued. The
laparotomy revealed that the
tumor was invading the right diaphragm. After 7 weeks of
lenvatinib administration after right portal vein transection, an extended right
hepatectomy with resection of the
tumor-invaded diaphragm was successfully done. The lung nodules that were suspected as
metastases had disappeared. The patient has been doing well without any sign of recurrence for 1 year.
CONCLUSION: