Long-term survival in a patient with hepatocellular carcinoma with resection of a metastatic lymph node after percutaneous ethanol injection therapy

Abstract

Lymph node (LN) metastases during operation for hepatocellular carcinoma (HCC), but not during operations for other cancer, as many surgeons can attest. We performed partial hepatectomy with LN dissection in a man with LN metstasis from HCC, and long-term survival was achieved. In December 1993, at another hospital, a tumor, 4.2 cm in diameter, in this 73-year-old patient had been diagnosed as HCC. Transcatheter arterial embolization (TAE) was performed three times Eighteen months after the operation, a swollen LN was discovered at the hepatic hilum and was treated by TAE once and by transcatheter arterial infusion (TAI) twice. However, the level of alpha-fetoprotein gradually increased and so percutaneous ethanol injection therapy (PEIT) was performed. Nevertheless, serum PIVKA-II (protein induced by vitamin K absence or antagonist II) continued to rise. The patient was referred to our hospital for further treatment. He underwent S5 subsegmentectomy with LN dissection. Histologically, the primary lesion consisted entirely of necrotic tissue. However, in the resected LN, there was residual cancer tissue near its periphery. We concluded that dissection of the affected LN offered the only chance for long-term survival, and that PEIT should be avoided for a metastatic lymph node.