PMC3278636_01
Initial abdominal ultrasonography and computed tomography. Four lesions in left lobe and 5 lesions in right lobe were found (white arrow, metastases in left lobe; black arrow, metastases in right lobe).
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F1
Nine metastatic lesions were preoperatively detected in the liver (5 lesions in the right lobe and 4 lesions in the left lobe) (Fig. 1).
(A) Abdominal computed tomography (CT) that was checked the day after first hepatectomy. Expected remnant liver volume was measured to be 29.5%. (B) Abdominal CT that was performed three weeks after first hepatectomy. Expected remnant liver volume increased to 35.8%. (C) Hypertrophied left lobe found in second hepatectomy. (D) Right hepatectomy was performed according to anatomical demarcation line.
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F2
Abdominal computed tomography (CT) was checked the day after the first operation and the expected remnant liver volume was measured at 29.5% (Fig. 2A). Abdominal CT was performed three weeks after the first operation and the expected remnant liver volume had increased to 35.8% (Fig. 2B). Hypertrophied left lobe was found (Fig. 2C). Therefore, the right hepatectomy was safely performed (Fig. 2D).
(A) Abdominal computed tomography (CT) taken at 15 months after second-stage hepatectomy showed no recurrent lesion. (B) Magnetic resonance image taken at 18 months after second-stage hepatectomy. Single recurrent mass (arrow) developed in remaining liver. (C) Abdominal CT checked after radiofrequency ablation (arrow, post-radiofrequency ablation lesion). (D) Abdominal CT taken at 14 months after radiofrequency ablation showed no other recurrent lesion (arrow, post-radiofrequency ablation lesion).
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F3
A recurred mass developed in segment III 18 months after the second liver operation (Fig. 3B).
Abdominal computed tomography and magnetic resonance image taken at 36 months after second-stage hepatectomy (arrows, multiple recurrent lesions).
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F4
Unfortunately, 5 other metastases developed 18 months after RFA (Fig. 4).
Abdominal computed tomography taken at 7 years after initial hepatectomy. No recurrent lesion was found.
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F5
He has survived for more than 7 years after the first operation (Fig. 5).