[A Case of Multiple Liver Metastases and Early Recurrence Managed with Repeated Hepatectomy and Chemotherapy Toward...

We report the case of a 46-year-old female who initially underwent laparoscopic sigmoidectomy for sigmoid colon cancer (pathological Stage Ⅲb, RAS mutant type)1 year prior. Postoperative adjuvant chemotherapy with 4 courses of CAPOX was administered. In January 2021, contrast-enhanced abdominal computed tomography revealed 11 liver metastases. Systemic chemotherapy with FOLFIRI+bevacizumab(BEV)was initiated, resulting in a partial response. A partial hepatectomy involving segments 4, 6, 7, and 8 was performed in July of the same year. Two new hepatic lesions were detected 3 months postoperatively, necessitating a second hepatectomy. Four months later, a solitary liver metastasis was identified, and the patient underwent a third hepatectomy following additional chemotherapy. Another solitary liver lesion was detected 4 months later, prompting a fourth hepatectomy, again preceded by chemotherapy. Six months after the fourth hepatectomy, a new hepatic lesion was found. At the patient's request, she underwent radiofrequency ablation(RFA)combined with transarterial embolization(TAE)at another institution. Subsequently, a right ovarian metastasis was identified and surgically resected. Four months following the RFA and TAE, 2 new liver metastases were discovered, and a fifth hepatectomy was performed after further chemotherapy. Infiltration into the right Glisson's branch was observed, and the surgical margin was positive. Postoperatively, FOLFIRI+BEV therapy was resumed. As of the latest follow-up, 4 year and 3 months after the initial diagnosis of multiple liver metastases, the patient remains under outpatient management and continues systemic therapy.