The patient was a 68-year-old woman without history of surgery. She presented with
abdominal pain and leg
edema. Ultrasound scan revealed hepatic masses. Colonoscopy and abdominal CT scan revealed unresectable rectal
carcinoma with massive multiple liver
metastases suspected of invasion of the inferior vena cava. After a transverse colon bi-pore
colostomy, 10 courses of FOLFOX plus
panitumumab therapy were administered, and the liver
tumor was markedly reduced in size and determined to be PR by CT. Considering the possibility of unresectability due to the liver
metastases re-growth, surgery was planned with liver-first approach(LFA). First, open resection of the right caudate lobe of the liver, combined resection of the IVC, combined resection of the diaphragm, partial hepatic S2 resection(2 sites), and
cholecystectomy were performed, followed by laparoscopic anterior resection(D3)1 month later(R0). Postoperatively, the
colostomy was closed after 8 courses of CapeOX(
capecitabine alone from the middle of the course). Now the patient is alive and recurrence-free 4 years after the initial diagnosis. Conversion surgery with LFA after
chemotherapy can be an effective treatment strategy for
colorectal cancer with advanced liver
metastases.