A long-term survival case of hepatocellular carcinoma with lymph node metastasis on the posterior surface of the pancreas head and portal vein tumor thrombus successfully treated with hepatopancreatoduodenectomy and adjuvant interferon-alpha and 5-fluorouracil combination therapy

A 72-year-old man, who had undergone partial hepatectomy for hepatocellular carcinoma (HCC), was admitted to our hospital for treatment of HCC recurrence. At laparotomy, intrahepatic metastasis on S6/1 with lymph node metastasis on the posterior surface of the pancreas head, suggesting direct invasion to pancreas, and portal vein tumor thrombus were identified. Hepatopancreatoduodenectomy and removal of the tumor thrombus was performed. Microscopic examination confirmed intrahepatic metastasis from HCC with portal vein tumor thrombus and lymph node metastasis. After the surgery, adjuvant interferon-alpha and 5-fluorouracil combination therapy was administered. Forty-one months after the surgery, solitary intrahepatic recurrence was identified, and radiofrequency ablation therapy was performed. Sixty-six months after the surgery, he remains in good condition without recurrence. This case suggests that some patients with HCC involving lymph node metastasis and portal vein tumor thrombus can gain a long-term survival by multifocal treatment including curative surgery, even if the surgical procedure is highly stressful, and adjuvant interferon-alpha and 5-fluorouracil combination therapy.