Long-term progression-free survival of hepatocellular carcinoma with synchronous diffuse peritoneal metastasis treated by CRS plus HIPEC A case report and literature review

Rationale: Hepatocellular carcinoma (HCC) with peritoneal metastasis (PM) is rare. There has been no standard treatment for this severe disease, and the conventional palliative therapy could only reach an overall survival of 6 to 14 months Patient concerns: A 38-year-old male with a chief complain of "abdominal distension and diagnosis of HCCPM for 3 months", was suffering from severe diarrhea and moderate anemia. Diagnosis: Diagnostic laparoscopic exploration with biopsy and the following pathology confirmed the diagnosis of HCC with PM. Interventions: The patient was treated with cytoreductive surgery (CRS) plus hyperthermic intraperitoneal chemotherapy (HIPEC) followed by 6 cycles of intraperitoneal chemotherapy and 6 cycles of intravenous chemotherapy. Outcomes: Till January 15, 2019, the patient has progression-free survival for over 22 months. Lessons: CRS plus HIPEC combined adjuvant intraperitoneal and intravenous chemotherapy may improve progression-free survival for some HCC with PM patients and should be considered as an option for such patients.