Carlos Eduardo R Santos, PhDBrazilian National Cancer Institute

Compagnon Hepatobiliaire

Synchronous Colorectal Liver Mets

M, 68y, 2009 Aortic Aneurism treated with

endoprotesis Mars 2011 Rectal Bleeding and Hepatic lesions

on USG

What to do?

Synchronous Colorectal Liver Mets

Abdominal Rectal Resection – Adeno G2 of 5 cm with lymphatic and neural invasion, No linfonodes in surgical especimen

Adjuvant Chemo Set 2011 Segmentectomy VI e Radioablation Mars 2012 Recurence on Pet CT com Seg VIII

with Right Hep Vein involvement

What to do?

Synchronous Colorectal Liver Mets

Chemotherapy with FOLFOX Pet CT 25/06/12 Neg MR 28/08/12 lesion on Seg VI, VII and VIII

stable – Indication oh Hepatectomy – Stop Chemo

October 2012 – Espiritual Surgery

What to do?

Synchronous Colorectal Liver Mets

Observation 23/01/13 Growing Lesions in PET CT

12/12/12 and MR 11/01/13 Pre op left Ureteral Catheter Eco Hipocinesy postero-Latero-Basal

on Left Vent – ASA III 20/02/13 New lesion on Seg IV 2 cm

Synchronous Colorectal Liver Mets

Pet CT 12.12.12

Pet CT 12.12.12

MR 11.01.13

Volumetric CT 14.02.13

Right Hepatic Vein

Radioablation Recurrence

3rd Lesion seg V

Volumetric CT 14.02.13

Artery

Volumetric CT 14.02.13

Portal Vein

Volumetric CT 14.02.13

Volumetry

Volumetric CT 14.02.13

What to do?

Synchronous Colorectal Liver Mets

02/03/13 Hepatectomy with

invasion of Rigth Portal Vein,

Retrohepatic IVC and Rigth Hepatic Vein,

and Nodulectomy Seg IV

Synchronous Colorectal Liver Mets

Caval Stapler Line

Caval Stapler Line

Seg IV resection

Final Aspect

Radiofrequency and Recurrence aspect

Radiofrequency and Recurrence aspect

Radiofrequency and Recurrence aspect

Radiofrequency and Recurrence aspect

Caval Invasion and Cava Graft

No more Chemo

Abdo CT 09/07/13 No new lesions until today

14 months

Synchronous Colorectal Liver Mets with IVC Resection

Post Op CT 09/07/13