[Multidisciplinary treatment for hepatocellular carcinoma invading the stomach]

The patient was a 69-year-old man who was found to be positive for the hepatitis C antibody in 1996. Hepatocellular carcinoma (HCC) was found in S4 and S7 in April 2000. He received treatment by transcatheter arterial chemoembolization (TACE) 3 times and by percutaneous ethanol injection therapy 1 time. At that point pulmonary metastasis was found. In November 2001 he was urgently admitted with hematemesis to the Department of Gastroenterology and Hepatology of our hospital. Bleeding from the HCC invading the stomach was found by endoscopy. Bleeding was successfully stopped by TACE. Because of the dangerousness of severe bleeding due to the disintegration of the HCC, we carried out a partial hepatectomy with partial gastrectomy and partial excision of the diaphragm. He recuperated at home after being discharged from the hospital, and sufficient QOL was maintained. In April of the same year, he vomited blood again and was readmitted. Endoscopy showed bleeding from a recurrence of the HCC in the stomach and a metastatic tumor at the lower esophagus. Bleeding was controlled by TACE and endoscopic procedures. The patient could maintain QOL under multidisciplinary therapy including surgery for the HCC, which was impossible to treat curatively. In such cases, it is important to use IVR or endoscopic procedures or a combination including them. Furthermore, in case of good hepatic reserve, surgery may then be added.