Anatomical hepatectomy for liver metastasis from rectal adenocarcinoma presenting with intrabiliary extension: a case report

Abstract

Liver metastases from colorectal carcinoma commonly form nodular lesions in the liver parenchyma. We report a case of liver metastasis from rectal adenocarcinoma that extended predominantly into the bile duct. A 62-year-old Japanese man underwent low anterior resection for rectal adenocarcinoma 9 years ago. Approximately 3 years later, he underwent radiofrequency ablation therapy for a metastatic liver tumor. Nine years after surgery, a tumor in liver segment III exhibiting intrabiliary extension was discovered; it was unclear if this was a metastatic liver tumor or intrahepatic cholangiocarcinoma. Accordingly, we performed a left hepatectomy with lymph node dissection. The tumor was negative for cytokeratins 7 and 20, and was histologically similar to the primary rectal adenocarcinoma; it was diagnosed as rectal carcinoma metastasis. The patient has survived for 3 years after the hepatic surgery, for 9 years after radiofrequency ablation therapy, and for 12 years after the primary surgery. This case shows that liver metastasis from colorectal carcinoma can present as a predominantly intrabiliary growth that mimics intrahepatic cholangiocarcinoma on imaging. Moreover, our case provides evidence for the superiority of anatomical hepatectomy over partial hepatectomy for metastatic liver tumors with intrabiliary growth arising from rectal adenocarcinomas.

Intrabiliary metastases in colorectal cancer: a systematic review

“…Surprisingly, it seems that patients with IBM have a better survival than patients without this metastasis . Patients with macroscopic involvement have a better prognosis, with a much higher 5‐year survival rate (80%) than those with microscopic involvement (48%) or no infiltration of the bile duct (57%) . Kubo et al.…”

“…This incidence is striking in a rare condition [31]. Estrella et al [17] note that this rate is lower (3.6%) in retrospective than in prospective studies (10.6%) [2,17]. This large percentage difference is due to the fact that the studies do not distinguish between a small degree of biliary invasion due to liver metastasis, which is relatively frequent, microscopic involvement, and a true macroscopic intrabiliary extension, which is rare [20,22].…”

“…Diagnosis of biliary tumors is not easy, despite the development of advanced radiological techniques such as CT, MRI and MRCP [3]. The differential diagnosis of IBM includes intrahepatic cholangiocarcinoma and intraductal papillary mucinous tumor of bile duct [2,3,6,7,21,30,31]. The clinical, analytical and radiological characteristics of these entities are similar, which makes differential diagnosis difficult [2,30].…”

“…The differential diagnosis of IBM includes intrahepatic cholangiocarcinoma and intraductal papillary mucinous tumor of bile duct [2,3,6,7,21,30,31]. The clinical, analytical and radiological characteristics of these entities are similar, which makes differential diagnosis difficult [2,30]. CT images show IBM to have a thickened portal tract, dilatation of the intrahepatic bile duct, a mass in the parenchyma contiguous to the intraductal lesion and/or expansile intraluminal growth [2,3,7,22,31].…”

“…Liver metastases emerge during the course of colorectal cancer (CRC) in 25-50% of patients [1]. They usually appear as nodular lesions in the hepatic parenchyma [2,3], but in a small proportion of patients they present intrabiliary growth. Intrabiliary metastases (IBM) have not been widely studied in the medical literature [2][3][4][5][6][7].…”