Cytoreductive surgery and HIPEC with oxaliplatin for the treatment of peritoneal carcinomatosis from recurrent fibrolamellar carcinoma

Fibrolamellar hepatocellular carcinoma (FHCC) is a rare variant of hepatocellular carcinoma (HCC), characterised by a poorer prognosis in later stages compared with conventional HCC due to a high rate of local recurrence, lymph node metastasis and peritoneal metastasis. Conventional chemotherapy is generally ineffective, making surgery the only potentially curative treatment. Currently, surgery is also indicated in cases of recurrence, always aiming for an R0 resection. We present the case of a young patient with peritoneal and retroperitoneal carcinomatosis following multiple resections, exhibiting a peculiar ‘sarcomatoid’ pattern of recurrence that is primarily local and not widespread within the abdomen. Immunotherapy was ineffective, and after the third recurrence, a cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy was performed. To date, there are no studies on the effectiveness of intraperitoneal chemotherapy in FHCC, though promising results have been observed for conventional HCC. As reported in two other articles in the literature, we attempted to apply this approach to FHCC.