Synchronous resection of colorectal liver metastasis- a case report

We present a case report of a young patient of Carcinoma sigmoid colon with multiple liver metastases who was managed with synchronous resection of colorectal liver metastasis. The patient had an ulceroproliferative growth in the sigmoid colon 18 cm from the anal verge with multiple bilobar liver metastases. The CEA level was 32 ng/ml. Preoperative evaluations of other organ systems was normal. He was managed with Segment VI sparing extended right hepatectomy, left hepatic metastatectomy and anterior resection with a stapled colorectal anastomosis with a covering loop ileostomy. Histopathological examination revealed moderately differentiated adenocarcinoma colon (pT3N2M1). Multiple metastastic nodules were present in all the specimens of resected liver with free margins of resection. He has received adjuvant combination chemotherapy with oxaliplatin + 5 FU + leucovorin in 21 day cycles (one cycle every 21 days) for a total period of 6 months. He has been in regular follow up for last 48 months and is doing well without any local or systemic relapse. With the low morbidity and mortality rates of modern day surgery we recommend synchronous resection of colorectal liver metastasis in a select group of patients in dedicated centres with specialized expertise in hepatobiliary surgery.