| Autor: |
Kraft A; Department of General Surgery, 'Regina Maria' Military Emergency Hospital, 500007 Brașov, Romania., Moldovan C; Department of General Surgery, Witting Clinical Hospital, 010243 Bucharest, Romania.; Department of Medical-Clinical Disciplines, Faculty of Medicine, 'Titu Maiorescu' University of Bucharest, 031593 Bucharest, Romania., Bârcu A; Doctoral School in Medicine, 'Titu Maiorescu' University, 040441 Bucharest, Romania., Dumitru R; Department of Radiology and Medical Imaging, 'Fundeni' Clinical Institute, 050474 Bucharest, Romania., Croitoru A; Department of Medical-Clinical Disciplines, Faculty of Medicine, 'Titu Maiorescu' University of Bucharest, 031593 Bucharest, Romania.; Department of Oncology, 'Fundeni' Clinical Institute, 022328 Bucharest, Romania., Herlea V; Department of Medical-Clinical Disciplines, Faculty of Medicine, 'Titu Maiorescu' University of Bucharest, 031593 Bucharest, Romania.; Department of Pathology, 'Fundeni' Clinical Institute, 022328 Bucharest, Romania., Popescu I; Department of Medical-Clinical Disciplines, Faculty of Medicine, 'Titu Maiorescu' University of Bucharest, 031593 Bucharest, Romania.; 'Dan Setlacec' Center for General Surgery and Liver Transplant, 'Fundeni' Clinical Institute, 022328 Bucharest, Romania., Botea F; Department of Medical-Clinical Disciplines, Faculty of Medicine, 'Titu Maiorescu' University of Bucharest, 031593 Bucharest, Romania.; 'Dan Setlacec' Center for General Surgery and Liver Transplant, 'Fundeni' Clinical Institute, 022328 Bucharest, Romania. |
| Abstrakt: |
Therapeutic decision-making for advanced GIST liver metastases is challenging due to limited clinical evidence. This case study aims to demonstrate the survival benefit of resection in non-responsive cases. A 40-year-old male presented with abdominal pain, weight loss, altered general status, massive hepatomegaly, and intermittent melaena. He was diagnosed with stage IV GIST with the primary tumor in the ileal loop and multiple gigantic synchronous bilobar liver metastases. Despite 31 months of tyrosine-kinase inhibitor therapy post-primary tumor resection, the disease remained unresponsive. The patient was admitted to our tertiary center with significant hepatomegaly. A two-stage debulking liver resection was performed after a multidisciplinary team decision. The first operation debulked the left hemiliver through a non-anatomical ultrasound-guided resection of segments 2, 3, and 4. The second operation (7 weeks later) debulked the right hemiliver through a right posterior sectionectomy involving segments 5 and 8. Despite receiving a second line of tyrosine-kinase inhibitor therapy after surgery, the disease progressed both within and outside the liver. However, the patient survived for 55 months, with a postoperative survival benefit of 25 months. In conclusion, this case emphasizes the significant survival benefit achieved through a complex two-stage debulking liver resection for giant liver metastases, even in cases where systemic therapy fails. |
