Duodenal metastasis of hepatocellular carcinoma following multimodal therapy: a rare case report and literature review

We present a rare case of duodenal metastasis of hepatocellular carcinoma (HCC) following multimodal therapy, in which the patient died shortly after the palliative surgical intervention. An 80-year-old man with HCC associated with chronic hepatitis B was admitted to our emergency department owing to complaints of anorexia and vomiting. He had undergone conversion surgery following systemic therapy that included a multikinase inhibitor and immune checkpoint inhibitors. Three months prior, transcatheter arterial chemoembolization and radiofrequency ablation had been performed for two intrahepatic recurrences. Contrast-enhanced abdominal computed tomography and upper gastrointestinal endoscopy revealed multiple intrahepatic recurrences, pulmonary metastases, and duodenal metastasis of HCC. Following the resolution of obstructive jaundice, the patient underwent palliative gastrojejunostomy. His postoperative course was complicated by progressive renal dysfunction and coagulopathy, and he died on postoperative day 15. In the literature review, including this case, 61 patients with duodenal involvement of HCC were identified. Although a small subset of patients achieved long-term survival after curative-intent surgery performed under highly selective conditions, the overall life expectancy for most patients remained poor. Even with palliative intent, surgical intervention for unresectable duodenal involvement caused by HCC should be pursued with careful consideration of the patient's prognosis and systemic condition.