ХІРУРГІЧНЕ ЛІКУВАННЯ МЕТАХРОННИХ МЕТАСТАЗІВ У ПЕЧІНКУ ПІСЛЯ WATCH-AND-WAIT СТРАТЕГІЇ В ПАЦІЄНТІВ ІЗ РАКОМ ПРЯМОЇ КИШКИ З ПОВНОЮ КЛІНІЧНОЮ ВІДПОВІДДЮ: КЛІНІЧНИЙ ВИПАДОК
The watch-and-wait (W&W) strategy has become an accepted organ-preserving approach for rectal cancer patients who achieve a clinical complete response (cCR) after total neoadjuvant therapy (tNt). however, the occurrence of metachronous colorectal liver metastases (CRLM) in this setting p...
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Experimental Oncology| _version_ | 1868022654696423424 |
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| author | Burlaka, A. Mykytyuk, A. Bezverkhnyi, V. Sorokin, B. Makhmudov, D. Skyba, V. |
| author_facet | Burlaka, A. Mykytyuk, A. Bezverkhnyi, V. Sorokin, B. Makhmudov, D. Skyba, V. |
| author_institution_txt_mv | [
{
"author": "A. Burlaka",
"institution": "Department of Surgery, Anesthesiology and Intensive Care of Postgraduate Education of the National Medical University Bogomolets National Medical University, Kyiv, Ukraine"
},
{
"author": "A. Mykytyuk",
"institution": "Department of General Surgery, Kyiv City Clinical Hospital No. 1 (Municipal Non-Profit Enterprise), Kyiv, Ukraine"
},
{
"author": "V. Bezverkhnyi",
"institution": "Military Hospital, Irpin, Ukraine"
},
{
"author": "B. Sorokin",
"institution": "Shupyk National Healthcare University, Kyiv, Ukraine"
},
{
"author": "D. Makhmudov",
"institution": "Hepatopancreatobiliary Surgery Department of the National Cancer Institute, Kyiv, Ukraine"
},
{
"author": "V. Skyba",
"institution": "Department of Surgery, Anesthesiology and Intensive Care of Postgraduate Education of the National Medical University Bogomolets National Medical University, Kyiv, Ukraine"
}
] |
| author_sort | Burlaka, A. |
| baseUrl_str | https://exp-oncology.com.ua/index.php/Exp/oai |
| collection | OJS |
| datestamp_date | 2026-06-14T20:08:49Z |
| description | The watch-and-wait (W&W) strategy has become an accepted organ-preserving approach for rectal cancer patients who achieve a clinical complete response (cCR) after total neoadjuvant therapy (tNt). however, the occurrence of metachronous colorectal liver metastases (CRLM) in this setting presents important therapeutic challenges. Evidence regarding the optimal surgical strategy—particularly the role of laparoscopic anatomical resection in centrally located liver segments—remains limited. We report the case of a 54-year-old male with ct3N0M0 rectal adenocarcinoma who achieved cCR following tNt and was subsequently managed with a W&W strategy. During routine surveillance, a soli- tary metachronous liver metastasis (15 mm) was detected in segment 4b. After a multidisciplinary tumor board review, the patient underwent laparoscopic anatomical segment 4b resection using an intrahepatic Glissonean approach. The postoperative course was uneventful, and the patient was discharged on postoperative day 6. histopathological exami- nation confirmed metastatic moderately differentiated adenocarcinoma with a microsatellite stable (MSS) phenotype and KRAS/BRAF wild-type status. This case demonstrates that laparoscopic anatomical segment 4b resection is a safe and feasible option for carefully selected patients with metachronous CRLM managed within a W&W strategy. The minimally invasive anatomical approach allowed precise vascular control and achievement of oncologically adequate margins in a technically demanding central segment. Larger clinical series are needed to define optimal management strategies and long-term oncologic outcomes in this setting. |
| doi_str_mv | 10.15407/exp-oncology.2026.01.059 |
| first_indexed | 2026-06-15T01:00:28Z |
| format | Article |
| fulltext |
ISSN 1812-9269. Experimental Oncology 48 (1). 2026 59
CASE REPORT
C i t a t i o n: Burlaka A, Mykytyuk A, Bezverkhnyi V, Sorokin B, Makhmudov D, Skyba V. Surgical management of meta-
chronous liver metastasis after watch-and-wait strategy in rectal cancer patients with complete response: A case report.
Exp Oncol. 2026; 48(1): 59-66. https://doi.org/10.15407/exp-oncology.2026.01.059
© PH “Akademperiodyka” of the NAS of Ukraine, 2026. This is an open access article under the CC BY-NC-ND license
(https://creativecommons.org/licenses/by-nc-nd/4.0/)
https://doi.org/10.15407/exp-oncology.2026.01.059
A. Burlaka 1, 2, A. Mykytyuk 3, *, V. Bezverkhnyi 4,
B. Sorokin 5, D. Makhmudov 2, V. Skyba 1
1 Department of Surgery, Anesthesiology and Intensive Care
of Postgraduate Education of the National Medical University
Bogomolets National Medical University, Kyiv, Ukraine
2 Hepatopancreatobiliary Surgery Department
of the National Cancer Institute, Kyiv, Ukraine
3 Department of General Surgery, Kyiv City
Clinical Hospital No. 1 (Municipal Non-Profit Enterprise), Kyiv, Ukraine
4 Military Hospital, Irpin, Ukraine
5 Shupyk National Healthcare University, Kyiv, Ukraine
* Correspondence: E-mail: mikityuk9797@gmail.com
Surgical Management of Metachronous
Liver Metastasis after Watch-and-Wait
Strategy in Rectal Cancer Patients
with Complete Response: A Case Report
The watch-and-wait (W&W) strategy has become an accepted organ-preserving approach for rectal cancer patients
who achieve a clinical complete response (cCR) after total neoadjuvant therapy (TNT). However, the occurrence of
metachronous colorectal liver metastases (CRLM) in this setting presents important therapeutic challenges. Evidence
regarding the optimal surgical strategy—particularly the role of laparoscopic anatomical resection in centrally located
liver segments—remains limited. We report the case of a 54-year-old male with cT3N0M0 rectal adenocarcinoma who
achieved cCR following TNT and was subsequently managed with a W&W strategy. During routine surveillance, a soli-
tary metachronous liver metastasis (15 mm) was detected in segment 4b. After a multidisciplinary tumor board review,
the patient underwent laparoscopic anatomical segment 4b resection using an intrahepatic Glissonean approach. The
postoperative course was uneventful, and the patient was discharged on postoperative day 6. Histopathological exami-
nation confirmed metastatic moderately differentiated adenocarcinoma with a microsatellite stable (MSS) phenotype
and KRAS/BRAF wild-type status. This case demonstrates that laparoscopic anatomical segment 4b resection is a safe
and feasible option for carefully selected patients with metachronous CRLM managed within a W&W strategy. The
minimally invasive anatomical approach allowed precise vascular control and achievement of oncologically adequate
margins in a technically demanding central segment. Larger clinical series are needed to define optimal management
strategies and long-term oncologic outcomes in this setting.
Keywords: laparoscopic liver resection, rectal cancer, watch-and-wait strategy, clinical complete response, metachro-
nous liver metastasis, anatomical segment 4b resection.
60 ISSN 1812-9269. Experimental Oncology 48 (1). 2026
A. Burlaka, A. Mykytyuk, V. Bezverkhnyi, B. Sorokin, D. Makhmudov, V. Skyba
Significant progress in rectal cancer surgery was
achieved in 1982, when B. Heald introduced the
principles of total mesorectal excision (TME) [1].
This technique enabled removal of primary rectal
tumors along the embryological plane, with dis-
section performed within the relatively avascular
space between the visceral and parietal fascia, sig-
nificantly reducing local recurrence rates [1, 2].
TME subsequently became the foundation of
modern multimodal rectal cancer (RC) treatment
strategies. One of the major advancements in this
field has been the implementation of total neoad-
juvant therapy (TNT) for the locally advanced
distal RC [3]. TNT has been shown to increase
rates of clinical complete response (cCR) and im-
prove disease-free survival. The most important
advantage of achieving cCR is the potential for
organ preservation without compromising qual-
ity of life. However, the rate of cCR following
TNT is approximately 20%, and reported 5-year
overall survival rates may reach up to 95% in se-
lected patients [4]. The watch-and-wait (W&W)
strategy for patients achieving cCR after TNT has
become increasingly standardized following the
results of the OPRA trial [5]. Nevertheless, this
approach carries inherent risks, including the lo-
cal tumor regrowth and distant metastatic pro-
gression [6]. The randomized and registry-based
data indicate that the local regrowth occurs in ap-
proximately 25% of patients within two years,
while distant metastases develop in 8%—30% of
cases [7]. In parallel, minimally invasive surgery
has demonstrated clear advantages over open ap-
proaches, including reduced surgical trauma and
faster postoperative recovery [8]. Laparoscopic
liver resection (LLR), particularly for minor re-
sections, has shown favorable short-term out-
comes in specialized centers [8—10]. The studies
report a lower morbidity, shorter hospital stay,
and earlier return to daily activities compared
with open liver surgery [11]. Moreover, random-
ized data suggest that LLR performed by experi-
enced teams achieves oncologic outcomes com-
parable to open surgery [12]. However, specific
recommendations regarding the optimal surgical
approach for metachronous liver metastases in
rectal cancer patients managed with a W&W
strategy after TNT remain lacking. The aim of
this study is to present a clinical case of laparo-
scopic anatomical resection of a metachronous
liver metastasis in a patient with rectal cancer who
achieved cCR following TNT.
Case presentation
The surgical procedure was performed by the he-
patopancreatobiliary (HPB) team at the National
Cancer Institute (Kyiv, Ukraine). The detailed cli
nical course, including initial diagnosis, TNT, con-
firmation of the cCR, development of metachro-
nous liver metastasis, multidisciplinary tumor
board (MDT) decision-making, and preoperative
evaluation, is described below.
A 54-year-old male presented to the National
Cancer Institute with a history of rectal cancer pre-
viously treated with TNT. During routine fol-
low-up, radiologic evaluation revealed disease pro-
gression in the form of a solitary metachronous liv-
er metastasis. At the initial diagnosis in December
2023, the tumor was staged as cT3N0M0 (stage
IIA) according to the AJCC TNM classification
(8th edition). The diagnosis was established
during a routine colonoscopy, which identified a
suspicious rectal lesion. Histopathological exam-
ination confirmed a well-to-moderately differen-
tiated (G1—G2) rectal adenocarcinoma. Between
January and February 2024, the patient under-
went a long-course pelvic radiotherapy to a total
dose of 50.4 Gy delivered in 28 fractions, with
concomitant capecitabine (825 mg/m² twice dai-
ly). This was followed by eight cycles of FOLFOX-6
chemotherapy initiated in March 2024 as part of
TNT. Restaging performed nine weeks after com-
pletion of treatment, including high-resolution
pelvic MRI, PET-CT, and endoscopic assessment,
demonstrated a cCR of the rectal tumor. MRI
showed magnetic resonance tumor regression
grade (mrTRG) 1 with no residual wall thicken-
ing, no restricted diffusion, no residual mass on
diffusion-weighted imaging, and no suspicious
lymphadenopathy in either the coronal (Fig. 1) or
sagittal planes (Fig. 2). The flexible endoscopy
confirmed the normalization of the rectal mucosa,
characterized by whitening and telangiectasia
without a visible residual tumor. According to the
international response criteria, these findings
were consistent with the complete radiologic and
endoscopic response.
The routine follow-up included contrast-en-
hanced pelvic MRI and CT of the chest, abdomen,
ISSN 1812-9269. Experimental Oncology 48 (1). 2026 61
Surgical Management of Metachronous Liver Metastasis after Watch-and-Wait Strategy in Rectal Cancer Patients
and pelvis according to international surveillance
protocols [13]. In December 2024 CT, the appear-
ance of a new hypodense lesion in segment 4b of
the liver was evident. The final lesion localization
was confirmed on contrast-enhanced MRI as seg-
ment 4b, which determined the operative anatom-
ical strategy (Fig. 3).
The patient underwent a full preoperative eval-
uation with no comorbidities and was classified as
ASA I. Also, there was no relevant drug use, family
history (including hereditary cancer syndromes),
or psychosocial concerns.
The patient’s clinical course followed a clearly
defined chronological sequence. In December
2023, he was diagnosed with cT3N0M0 rectal ade-
nocarcinoma. Between January and February 2024,
he underwent long-course pelvic radiotherapy
(50.4 Gy in 28 fractions) with concomitant capeci
tabine. From March to July 2024, eight cycles of
FOLFOX-6 were administered as part of TNT.
In September 2024, the comprehensive restag-
ing, including high-resolution pelvic MRI, PET-CT,
and endoscopic evaluation, confirmed a cCR.
A structured W&W surveillance program was sub-
sequently initiated.
In December 2024, a routine follow-up imaging
detected a solitary metachronous liver metastasis
in segment 4b. After MDT evaluation, surgical
Fig. 1. Axial T2-weighted MRI sequences before and after treatment demonstrating cCR (mrTRG 1)
Fig. 2. Sagittal T2-weighted MRI sequences before and after treatment confirming cCR (mrTRG 1)
62 ISSN 1812-9269. Experimental Oncology 48 (1). 2026
A. Burlaka, A. Mykytyuk, V. Bezverkhnyi, B. Sorokin, D. Makhmudov, V. Skyba
treatment was recommended. In January 2025,
the patient underwent laparoscopic anatomical
segment 4b resection.
Examination results and planning of treatment
tactics. The routine laboratory tests revealed no ab-
normality. The patient’s serum carcinoembryonic
antigen (CEA) level was elevated at 25.8 ng/mL,
while CA 19-9 remained within normal limits. Tu-
mor marker levels did not influence surgical deci-
sion-making. Contrast-enhanced abdominal CT
and MRI identified a solitary hepatic lesion in seg-
ment 4b measuring 15 mm (Fig. 3). Given the con-
firmed cCR of the primary tumor after TNT, the
MDT recommended continuation of the non-op-
erative W&W strategy for the rectal lesion and sur-
gical management of the liver metastasis. The
choice of laparoscopic anatomical resection was
based on several considerations. The lesion was
solitary (15 mm) with no evidence of extrahepatic
disease, and the patient had preserved liver func-
tion and no comorbidity (ASA I). Due to its central
location in segment 4b and proximity to the major
vascular structures, an anatomical resection was
considered preferable to ensure complete portal
territory clearance and adequate oncologic mar-
gins. Furthermore, institutional experience in lap-
aroscopic anatomical liver resections supported the
minimally invasive approach. Preoperative prepa-
ration included standard thromboprophylaxis with
subcutaneous low-molecular-weight heparin.
Ligasure Maryland and bipolar/monopolar elec-
trocautery were used as laparoscopic surgical ener-
gy devices.
Surgical technique. The patient was positioned
in the supine split-leg position, with the surgeon
standing between his legs. After placement of a
12 mm umbilical port, pneumoperitoneum was
established using carbon dioxide insufflation, and
intra-abdominal pressure was maintained below
12 mm Hg. Four trocars were inserted under di-
rect vision (one 12 mm, two 10 mm, and one 5
mm) as shown in Fig. 3. The falciform and coro-
nary ligaments were divided in the cephalad di-
rection to mobilize the liver. Intraoperative ultra-
sonography was performed to confirm tumor lo-
cation and assess resection margins. The medial
transection line was marked along the right side
of the falciform ligament using electrocautery. An
intrahepatic Glissonean approach was used to
control the segment 4 pedicles. Parenchymal
transection was initiated along the right side of
the falciform ligament, followed by careful dis-
section to expose the segment 4 Glissonean ped-
icle. The subdivisional pedicle to segment 4b was
isolated and divided using Hem-o-lok clips
(Fig. 4). The resulting demarcation line on the
liver surface was used to guide anatomical paren-
chymal transection. Intermittent inflow control
was applied using a 14-Fr Foley catheter tourni-
quet technique (Huang method). Parenchymal
transection was completed using the clamp-crush-
ing technique (Fig. 5).
Operative time was 185 min, estimated blood
loss was 200 mL, and total Pringle maneuver du-
ration was 26 min. The patient had no postope
rative complications and was discharged on posto
perative day 6.
Pathological findings and follow-up. Histo-
pathological examination of the resected liver spe
cimens confirmed moderately differentiated ade-
nocarcinoma. Molecular genetic analysis revea
led MSS, KRAS, and BRAF of the wild type. The
patient continued regular follow-up with the
attending surgeon and clinical oncologist. Adju-
Fig. 3. Contrast-enhanced MRI (a) and CT (b) performed in December 2024, demonstrating a solitary lesion in segment 4b
ISSN 1812-9269. Experimental Oncology 48 (1). 2026 63
Surgical Management of Metachronous Liver Metastasis after Watch-and-Wait Strategy in Rectal Cancer Patients
vant chemotherapy with the FOLFOX-6 regimen
was recommended by the MDT based on the cur-
rent institutional protocol for the resected meta-
chronous colorectal liver metastases (CRLM),
considering the risk of systemic recurrence.
A non-operative W&W strategy was adopted for
the rectal lesion. The follow-up strategy included
clinical evaluation and serum CEA assessment ev-
ery 3 months over the first two years, with con-
trast-enhanced CT of the chest and abdomen ev-
ery 6 months, and pelvic MRI according to the
W&W surveillance protocol.
Discussion
This case highlights the importance of multidis-
ciplinary decisions in the course of the W&W
strategy in RC patients with cCR experience after
TNT. It is recommended to apply state-of-the-art
radiologic and endoscopic assessment to ensure
robust confirmation of cCR and support decision-
making regarding rectal organ preservation [14].
Data regarding the incidence and management of
CRLM in patients treated with a W&W strategy
remain limited. According to analyses from the
International W&W Database (IWWD), distant
metastases develop in approximately 8%—30% of
patients, particularly among those experiencing
local regrowth [6, 7]. Furthermore, long-term
data from the OPRA trial confirm that while or-
gan preservation is feasible, distant metastatic
progression remains a relevant clinical concern in
this population [5]. However, we lack specific sur-
gical recommendations for CRLM, arising in the
context of prior organ-preservation strategies, and
current management is generally extrapolated
from conventional CRLM treatment paradigms.
Nevertheless, the development of metastatic dis-
ease introduces additional clinical challenges and
requires individualized decision-making. The ad-
vancement of minimally invasive hepatobiliary
surgery has expanded therapeutic options for
metastatic liver disease, allowing effective onco-
logic treatment with reduced surgical trauma. The
laparoscopic anatomical resections in CRC pa-
tients with liver metastases remain a technically
demanding procedure, particularly when targe
ting lesions are located in central liver segments.
Segment 4b, positioned adjacent to key vascular
and biliary structures, presents specific challenges
due to its anatomical proximity to the left and
right hepatic pedicles, the middle hepatic vein,
and the gallbladder fossa [15, 16]. Precise anatom-
ical orientation and controlled dissection are
therefore critical to avoid vascular injury and en-
sure oncological safety. However, the foundation
of these procedures must be rooted in solid open
surgical experience and a thorough understanding
of intrahepatic vascular anatomy. Several contem-
porary studies have demonstrated that LLR
achieves oncological outcomes comparable to
open liver resection (OLR) in patients with
CRLM, with similar overall and disease-free sur-
vival rates [17, 18]. In addition, LLR has been as-
sociated with reduced intraoperative blood loss,
lower postoperative morbidity, and shorter hospi-
tal stay compared to OLR in selected patients [17,
19]. Although resections in the central liver seg-
ments remain technically demanding due to prox-
imity to major vascular structures, recent series
suggest that with appropriate expertise and ana-
tomical approaches, minimally invasive resections
Fig. 4. Intraoperative view of the isolated S4b Glissonean
pedicle
Fig. 5. Parenchymal transection following control of the
S4b Glissonean pedicle
64 ISSN 1812-9269. Experimental Oncology 48 (1). 2026
A. Burlaka, A. Mykytyuk, V. Bezverkhnyi, B. Sorokin, D. Makhmudov, V. Skyba
can be performed safely even in these challenging
locations [18, 20].
In our case, the laparoscopic anatomical resection
of segment 4b was performed successfully, with full
control of the segmental Glissonean pedicle and
clear exposure of the resection line. The minimally
invasive approach allowed achievement of R0 resec-
tion with clear gross and microscopic margins, min-
imal blood loss, and no need for conversion.
This case demonstrates that laparoscopic ana-
tomical segment 4b resection is a safe and feasible
option for carefully selected patients with meta-
chronous CRLM managed within a W&W strategy.
The minimally invasive anatomical approach al-
lowed precise vascular control and achievement of
oncologically adequate margins in a technically de-
manding central segment. Larger clinical series are
needed to define optimal management strategies
and long-term oncologic outcomes in this setting.
Limitations
This report represents a single clinical observation
and therefore does not allow generalization of out-
comes or comparison with alternative surgical
strategies. No comparative analysis between the
laparoscopic and open approaches in this specific
clinical scenario can be made. Long-term oncolog-
ic results remain unavailable due to the relatively
short follow-up period. Furthermore, evidence
guiding management of metachronous CRLM in
patients treated with a W&W strategy after TNT is
limited, and current decision-making relies largely
on extrapolation from conventional CRLM treat-
ment paradigms.
Conflict of interest
The authors declare no conflict of interest.
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Submitted: November 25, 2025
A. Бурлака 1, 2, A. Микитюк 3, В. Безверхній 4,
Б. Сорокін 5, Д. Махмудов ², В. Скиба ¹
1 Кафедра хірургії, анестезіології та інтенсивної терапії
післядипломної освіти Національного медичного університету
імені О.О. Богомольця, Київ, Україна
2 Відділення гепатопанкреатобіліарної хірургії
Національного інституту раку, Київ, Україна
3 Відділення загальної хірургії, Київська міська
клінічна лікарня № 1 (КНП), Київ, Україна
4 Військовий госпіталь, Ірпінь, Україна
5 Національний університет охорони здоров’я України
імені П.Л. Шупика, Київ, Україна
ХІРУРГІЧНЕ ЛІКУВАННЯ МЕТАХРОННИХ МЕТАСТАЗІВ
У ПЕЧІНКУ ПІСЛЯ WATCH-AND-WAIT СТРАТЕГІЇ
В ПАЦІЄНТІВ ІЗ РАКОМ ПРЯМОЇ КИШКИ З ПОВНОЮ
КЛІНІЧНОЮ ВІДПОВІДДЮ: КЛІНІЧНИЙ ВИПАДОК
Стратегія watch-and-wait (W&W) стала визнаним органозберігаючим підходом для пацієнтів із раком прямої
кишки, які досягли повної клінічної відповіді після тотальної неоад’ювантної терапії (TНT). Однак виникнен-
ня метахронних колоректальних метастазів у печінку в цій когорті створює важливі терапевтичні виклики.
Дані щодо оптимальної хірургічної стратегії, зокрема, ролі лапароскопічної анатомічної резекції центрально
розташованих сегментів печінки залишаються обмеженими. Представлено випадок 54-річного чоловіка з аде-
нокарциномою прямої кишки cT3N0M0, який досяг повної клінічної відповіді після проведення TНT і надалі
перебував під спостереженням за стратегією W&W. Під час рутинного моніторингу виявлено солітарний мета-
хронний метастаз у печінку (15 мм) у сегменті 4b. Після розгляду випадку на мультидисциплінарному онко-
логічному консиліумі пацієнту виконано лапароскопічну анатомічну резекцію сегмента 4b із застосуванням
внутрішньопечінкового гліссонового доступу. Післяопераційний перебіг — без ускладнень, пацієнта виписано
на шосту післяопераційну добу. Гістопатологічне дослідження підтвердило метастатичну помірно диференці-
йовану аденокарциному з мікросателітною стабільністю та статусом KRAS/BRAF дикого типу. Цей клінічний
випадок демонструє, що лапароскопічна анатомічна резекція сегмента 4b є безпечним і виконуваним методом
лікування в ретельно відібраних пацієнтів із метахронними колоректальними метастазами в печінку в межах
стратегії W&W. Мінімально інвазивний анатомічний підхід забезпечив точний судинний контроль і досягнен-
ня онкологічно адекватних країв резекції в технічно складному центральному сегменті. Для визначення опти-
мальної тактики лікування та оцінки віддалених онкологічних результатів у цій категорії пацієнтів необхідні
подальші клінічні дослідження.
Ключові слова: лапароскопічна резекція печінки, рак прямої кишки, watch-and-wait, повна клінічна відповідь,
метахронний метастаз у печінку, анатомічна резекція сегмента 4b.
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| id | oai:ojs2.ex.aqua-time.com.ua:article-619 |
| institution | Experimental Oncology |
| keywords_txt_mv | keywords |
| language | English |
| last_indexed | 2026-06-15T01:00:28Z |
| publishDate | 2026 |
| publisher | PH Akademperiodyka |
| record_format | ojs |
| resource_txt_mv | exp-oncologycomua/ee/4d3dab824bd63d3c43c96474afbdd8ee.pdf |
| spelling | oai:ojs2.ex.aqua-time.com.ua:article-6192026-06-14T20:08:49Z Surgical Management of Metachronous Liver Metastasis after Watch-and-Wait Strategy in Rectal Cancer Patients with Complete Response: A Case Report ХІРУРГІЧНЕ ЛІКУВАННЯ МЕТАХРОННИХ МЕТАСТАЗІВ У ПЕЧІНКУ ПІСЛЯ WATCH-AND-WAIT СТРАТЕГІЇ В ПАЦІЄНТІВ ІЗ РАКОМ ПРЯМОЇ КИШКИ З ПОВНОЮ КЛІНІЧНОЮ ВІДПОВІДДЮ: КЛІНІЧНИЙ ВИПАДОК Burlaka, A. Mykytyuk, A. Bezverkhnyi, V. Sorokin, B. Makhmudov, D. Skyba, V. лапароскопічна резекція печінки, рак прямої кишки, watch-and-wait, повна клінічна відповідь, метахронний метастаз у печінку, анатомічна резекція сегмента 4b laparoscopic liver resection, rectal cancer, watch-and-wait strategy, clinical complete response, metachro- nous liver metastasis, anatomical segment 4b resection The watch-and-wait (W&W) strategy has become an accepted organ-preserving approach for rectal cancer patients who achieve a clinical complete response (cCR) after total neoadjuvant therapy (tNt). however, the occurrence of metachronous colorectal liver metastases (CRLM) in this setting presents important therapeutic challenges. Evidence regarding the optimal surgical strategy—particularly the role of laparoscopic anatomical resection in centrally located liver segments—remains limited. We report the case of a 54-year-old male with ct3N0M0 rectal adenocarcinoma who achieved cCR following tNt and was subsequently managed with a W&W strategy. During routine surveillance, a soli- tary metachronous liver metastasis (15 mm) was detected in segment 4b. After a multidisciplinary tumor board review, the patient underwent laparoscopic anatomical segment 4b resection using an intrahepatic Glissonean approach. The postoperative course was uneventful, and the patient was discharged on postoperative day 6. histopathological exami- nation confirmed metastatic moderately differentiated adenocarcinoma with a microsatellite stable (MSS) phenotype and KRAS/BRAF wild-type status. This case demonstrates that laparoscopic anatomical segment 4b resection is a safe and feasible option for carefully selected patients with metachronous CRLM managed within a W&W strategy. The minimally invasive anatomical approach allowed precise vascular control and achievement of oncologically adequate margins in a technically demanding central segment. Larger clinical series are needed to define optimal management strategies and long-term oncologic outcomes in this setting. Стратегія watch-and-wait (W&W) стала визнаним органозберігаючим підходом для пацієнтів із раком прямої кишки, які досягли повної клінічної відповіді після тотальної неоад’ювантної терапії (tНt). Однак виникнення метахронних колоректальних метастазів у печінку в цій когорті створює важливі терапевтичні виклики. Дані щодо оптимальної хірургічної стратегії, зокрема, ролі лапароскопічної анатомічної резекції центрально розташованих сегментів печінки залишаються обмеженими. Представлено випадок 54-річного чоловіка з аденокарциномою прямої кишки ct3N0M0, який досяг повної клінічної відповіді після проведення tНt і надалі перебував під спостереженням за стратегією W&W. Під час рутинного моніторингу виявлено солітарний метахронний метастаз у печінку (15 мм) у сегменті 4b. Після розгляду випадку на мультидисциплінарному онкологічному консиліумі пацієнту виконано лапароскопічну анатомічну резекцію сегмента 4b із застосуванням внутрішньопечінкового гліссонового доступу. Післяопераційний перебіг — без ускладнень, пацієнта виписано на шосту післяопераційну добу. Гістопатологічне дослідження підтвердило метастатичну помірно диференційовану аденокарциному з мікросателітною стабільністю та статусом KRAS/BRAF дикого типу. Цей клінічний випадок демонструє, що лапароскопічна анатомічна резекція сегмента 4b є безпечним і виконуваним методом лікування в ретельно відібраних пацієнтів із метахронними колоректальними метастазами в печінку в межах стратегії W&W. Мінімально інвазивний анатомічний підхід забезпечив точний судинний контроль і досягнення онкологічно адекватних країв резекції в технічно складному центральному сегменті. Для визначення оптимальної тактики лікування та оцінки віддалених онкологічних результатів у цій категорії пацієнтів необхідні подальші клінічні дослідження. PH Akademperiodyka 2026-06-14 Article Article application/pdf https://exp-oncology.com.ua/index.php/Exp/article/view/619 10.15407/exp-oncology.2026.01.059 Experimental Oncology; Vol. 48 No. 1 (2026): Experimental Oncology; 59-65 Експериментальна онкологія; Том 48 № 1 (2026): Експериментальна онкологія; 59-65 2312-8852 1812-9269 10.15407/exp-oncology.2026.01 en https://exp-oncology.com.ua/index.php/Exp/article/view/619/464 Copyright (c) 2026 Experimental Oncology https://creativecommons.org/licenses/by-nc-nd/4.0/ |
| spellingShingle | лапароскопічна резекція печінки рак прямої кишки watch-and-wait повна клінічна відповідь метахронний метастаз у печінку анатомічна резекція сегмента 4b Burlaka, A. Mykytyuk, A. Bezverkhnyi, V. Sorokin, B. Makhmudov, D. Skyba, V. ХІРУРГІЧНЕ ЛІКУВАННЯ МЕТАХРОННИХ МЕТАСТАЗІВ У ПЕЧІНКУ ПІСЛЯ WATCH-AND-WAIT СТРАТЕГІЇ В ПАЦІЄНТІВ ІЗ РАКОМ ПРЯМОЇ КИШКИ З ПОВНОЮ КЛІНІЧНОЮ ВІДПОВІДДЮ: КЛІНІЧНИЙ ВИПАДОК |
| title | ХІРУРГІЧНЕ ЛІКУВАННЯ МЕТАХРОННИХ МЕТАСТАЗІВ У ПЕЧІНКУ ПІСЛЯ WATCH-AND-WAIT СТРАТЕГІЇ В ПАЦІЄНТІВ ІЗ РАКОМ ПРЯМОЇ КИШКИ З ПОВНОЮ КЛІНІЧНОЮ ВІДПОВІДДЮ: КЛІНІЧНИЙ ВИПАДОК |
| title_alt | Surgical Management of Metachronous Liver Metastasis after Watch-and-Wait Strategy in Rectal Cancer Patients with Complete Response: A Case Report |
| title_full | ХІРУРГІЧНЕ ЛІКУВАННЯ МЕТАХРОННИХ МЕТАСТАЗІВ У ПЕЧІНКУ ПІСЛЯ WATCH-AND-WAIT СТРАТЕГІЇ В ПАЦІЄНТІВ ІЗ РАКОМ ПРЯМОЇ КИШКИ З ПОВНОЮ КЛІНІЧНОЮ ВІДПОВІДДЮ: КЛІНІЧНИЙ ВИПАДОК |
| title_fullStr | ХІРУРГІЧНЕ ЛІКУВАННЯ МЕТАХРОННИХ МЕТАСТАЗІВ У ПЕЧІНКУ ПІСЛЯ WATCH-AND-WAIT СТРАТЕГІЇ В ПАЦІЄНТІВ ІЗ РАКОМ ПРЯМОЇ КИШКИ З ПОВНОЮ КЛІНІЧНОЮ ВІДПОВІДДЮ: КЛІНІЧНИЙ ВИПАДОК |
| title_full_unstemmed | ХІРУРГІЧНЕ ЛІКУВАННЯ МЕТАХРОННИХ МЕТАСТАЗІВ У ПЕЧІНКУ ПІСЛЯ WATCH-AND-WAIT СТРАТЕГІЇ В ПАЦІЄНТІВ ІЗ РАКОМ ПРЯМОЇ КИШКИ З ПОВНОЮ КЛІНІЧНОЮ ВІДПОВІДДЮ: КЛІНІЧНИЙ ВИПАДОК |
| title_short | ХІРУРГІЧНЕ ЛІКУВАННЯ МЕТАХРОННИХ МЕТАСТАЗІВ У ПЕЧІНКУ ПІСЛЯ WATCH-AND-WAIT СТРАТЕГІЇ В ПАЦІЄНТІВ ІЗ РАКОМ ПРЯМОЇ КИШКИ З ПОВНОЮ КЛІНІЧНОЮ ВІДПОВІДДЮ: КЛІНІЧНИЙ ВИПАДОК |
| title_sort | хірургічне лікування метахронних метастазів у печінку після watch-and-wait стратегії в пацієнтів із раком прямої кишки з повною клінічною відповіддю: клінічний випадок |
| topic | лапароскопічна резекція печінки рак прямої кишки watch-and-wait повна клінічна відповідь метахронний метастаз у печінку анатомічна резекція сегмента 4b |
| topic_facet | лапароскопічна резекція печінки рак прямої кишки watch-and-wait повна клінічна відповідь метахронний метастаз у печінку анатомічна резекція сегмента 4b laparoscopic liver resection rectal cancer watch-and-wait strategy clinical complete response metachro- nous liver metastasis anatomical segment 4b resection |
| url | https://exp-oncology.com.ua/index.php/Exp/article/view/619 |
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