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Management of very late peritoneal metastasis of hepatocellular carcinoma 10 years after liver transplantation: Lessons from two cases
Ann Hepatobiliary Pancreat Surg 2018 May;22(2):136-43
Published online May 31, 2018
Copyright © 2018 Ann Hepatobiliary Pancreat Surg.

bdulwahab A Alshahrani1,2, Shin Hwang1, Gi-Won Song1, Deok-Bog Moon1, Dong-Hwan Jung1, Chul-Soo Ahn1, Ki-Hun Kim1, Tae-Yong Ha1, Gil-Chun Park1, Su-Min Ha1, Yo-Han Park3, and Sung-Gyu Lee1

1Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea, 2Multi Organ Transplant Center, King Fahad Specialist University Hospital, Dammam, Saudi Arabia, 3Department of Surgery, College of Medicine Inje University, Busan Paik Hospital, Busan, Korea
Received March 7, 2018; Revised March 20, 2018; Accepted April 10, 2018.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
 Abstract
Recurrence of hepatocellular carcinoma (HCC) 10 years after liver transplantation (LT) is very rare. Here, we present two cases of peritoneal metastasis of HCC that occurred 10 and 12 years after LT. A 77-year-old male who had under-gone deceased-donor LT 10 years earlier showed slow progressive elevation of tumor marker levels over 6 months. Close observation with frequent imaging studies and monthly tumor marker analyses revealed a solitary peritoneal seeding mass. Imaging studies revealed that the mass was highly likely to be metastatic HCC. After excision of the mass, all tumor markers returned to the normal range. Over past 10 months, the patient has received everolimus monotherapy and half-dose sorafenib, and has shown no evidence of HCC recurrence. In the second case, marginally elevated tumor marker levels were detected in a 65-year-old male who had undergone living-donor LT 12 years earlier. After observation for 3 months, follow-up studies revealed a peritoneal seeding mass. Thorough imaging studies re-vealed that the mass was highly likely to be metastatic HCC. Two mass lesions were excised, and the patient was administered low-dose calcineruin inhibitor, sirolimus, and full-dose sorafenib. Subsequently, the tumor marker levels increased again and growth of new peritoneal seeding nodules was observed; therefore, sorafenib was stopped after 2 years of administration. During 6 years since HCC recurrence diagnosis, the patient has experienced slowly growing tumors, but has been doing well. For very late peritoneal metastasis of HCC, the therapeutic modalities include surgical resection if possible, everolimus monotherapy, and long-term use of sorafenib. (Ann Hepatobiliary Pancreat Surg 2018;22:136-143)
Keywords : Hepatocellular carcinoma; Recurrence; Metastasis; Sorafenib; Resection