Hepatectomy After Yttrium-90 (Y90) Radioembolization-Induced Liver Fibrosis
| Autor: | Vijay K. Maker, Elliot Weisenberg, Ajay V. Maker, Carey Z. August |
|---|---|
| Rok vydání: | 2016 |
| Předmět: |
0301 basic medicine
myalgia Liver Cirrhosis medicine.medical_specialty medicine.medical_treatment Clinical Sciences Bead embolization Carcinoid Tumor Article Muscle hypertrophy 03 medical and health sciences Embolization Liver metastases 0302 clinical medicine Hepatic Artery Rare Diseases Fibrosis Nonalcoholic fatty liver disease Medicine Humans Hepatectomy Yttrium Radioisotopes Radioembolization Cancer Y90 biology business.industry Liver Disease Liver Neoplasms Gastroenterology Chromogranin A Middle Aged medicine.disease Embolization Therapeutic Surgery Ileal Neoplasms 030104 developmental biology 030220 oncology & carcinogenesis biology.protein Complete Metastasectomy Female medicine.symptom Therapeutic business Digestive Diseases Carcinoid syndrome |
| Zdroj: | Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract, vol 20, iss 4 |
| Popis: | An obese 55-year-old woman with nonalcoholic fatty liver disease presented 7 years after resection of a T3N1 ileal carcinoid tumor with an elevated chromogranin A, multifocal metastatic disease to the liver, and carcinoid syndrome. She underwent right hepatic artery yttrium-90 (Y90) radioembolization, followed a month later by selective Y90 treatment to segment IV. She then presented to our clinic 10 months later, remaining symptomatic with flushing, diarrhea, anxiety, myalgia, pain, and persistent night sweats despite Sandostatin administration. At least 11 tumors were identified in the right lobe of the liver and three in segment IV on liver-specific imaging. These lesions were stable over a year with no new lesions. At exploration, there was marked hypertrophy of the left lateral segment due to the yttrium-90 treatment of segments IV-VIII, corresponding with preoperative volumetrics predicting a functional liver remnant (FLR) of 40% after extended right hepatectomy. The right lobe and segment IV were fibrotic, hard, and visibly damaged. The gland had a thick, fibrotic capsule, and the parenchyma was dense, inflexible, and difficult to dissect, consistent with the previously reported morbidity of these operations. Extended right hepatectomy was performed. Final pathology demonstrated 15 foci of metastatic well-differentiated neuroendocrine carcinoma that were negative for necrosis, as was expected given her continued symptoms despite radioembolization. Numerous amorphous spheres, frequently in clusters, were present in segments IV-VIII in vessels and approximating tumors consistent with prior Y90 radioembolization. The patient had an uneventful post-operative recovery and remains symptom free on follow-up. Treatment options for metastatic tumors to the liver have increased in recent years and currently include radioembolization in selected patients. Surgical cytoreduction and complete metastasectomy continue to offer improvement in symptoms, quality of life, and survival in patients with neuroendocrine liver metastases; however, hepatectomy after radioembolization is unique and carries increased morbidity/mortality, likely due to Y90-induced liver fibrosis. We demonstrate images of fibrotic yttrium-90 radiation-affected liver and histological sections of radioembolic microbeads in blood vessels and distributed around resected tumors. |
| Databáze: | OpenAIRE |
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