Conversion surgery for recurrent hepatic angiosarcoma after systemic chemotherapy with paclitaxel.

Area of Science:

• Hepatobiliary surgery
• Oncology
• Vascular tumors

Background:

• Hepatic angiosarcoma is a rare and aggressive primary liver cancer.
• Ruptured hepatic tumors can present with life-threatening hemorrhagic shock.
• Surgical resection is the primary treatment, but recurrence is common.

Observation:

• A 67-year-old man with a ruptured hepatic angiosarcoma underwent emergency partial liver resection with positive margins.
• Recurrence was detected six months later, with tumors abutting the common bile duct and portal vein, deemed unresectable.
• The patient received four cycles of paclitaxel chemotherapy with an excellent response.

Findings:

• Conversion surgery included partial resection of segments S4 and S1, with a remnant right liver and middle hepatic vein, and wedge resection of a segment 3 metastatic lesion.
• The patient experienced a grade B bile leak postoperatively and was discharged on day 28.
• The patient remained disease-free for eight months following the conversion surgery.

Implications:

• This case demonstrates the efficacy of a neoadjuvant chemotherapy followed by conversion surgery for recurrent, initially unresectable hepatic angiosarcoma.
• Multidisciplinary treatment including chemotherapy and aggressive surgical management can lead to favorable outcomes in complex liver cancer cases.
• Further research into optimal treatment strategies for hepatic angiosarcoma is warranted.