Hepatectomy After Yttrium-90 (Y90) Radioembolization-Induced Liver Fibrosis

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• 作者：Ajay V. Maker ; Carey August ; Vijay K. Maker…
• 关键词：Y90 ; Radioembolization ; Hepatectomy ; Liver metastases ; Fibrosis ; Bead embolization
• 刊名：Journal of Gastrointestinal Surgery
• 出版年：2016
• 出版时间：April 2016
• 年：2016
• 卷：20
• 期：4
• 页码：869-870
• 全文大小：359 KB
• 参考文献：1.Teo JY, Allen JC, Jr., Ng DC, Choo SP, Tai DW, Chang JP et al. A systematic review of contralateral liver lobe hypertrophy after unilobar selective internal radiation therapy with Y90. HPB : the official journal of the International Hepato Pancreato Biliary Association. 2015. doi:10.​1111/​hpb.​12490 .
  2.Henry LR, Hostetter RB, Ressler B, Bowser I, Yan M, Vaghefi H et al. Liver resection for metastatic disease after y90 radioembolization: a case series with long-term follow-up. Annals of surgical oncology. 2015;22(2):467-74. doi:10.​1245/​s10434-014-4012-z .CrossRef PubMed
  3.Maxwell JE, Sherman SK, O'Dorisio TM, Bellizzi AM, Howe JR. Liver-directed surgery of neuroendocrine metastases: What is the optimal strategy? Surgery. 2016;159(1):320-35. doi:10.​1016/​j.​surg.​2015.​05.​040 .CrossRef PubMed
  
• 作者单位：Ajay V. Maker (1) (2) (3)
  Carey August (4)
  Vijay K. Maker (2) (3)
  Elliot Weisenberg (4)
  
  1. Division of Surgical Oncology, Department of Surgery, University of Illinois at Chicago, Chicago, IL, USA
  2. University of Illinois Metropolitan Group Hospitals Residency Program in General Surgery, Chicago, IL, USA
  3. Department of Surgery, Creticos Cancer Center at Advocate Illinois Masonic Medical Center, Chicago, IL, USA
  4. Department of Pathology, Creticos Cancer Center at Advocate Illinois Masonic Medical Center, Chicago, IL, USA
  
• 刊物主题：Surgery; Gastroenterology;
• 出版者：Springer US
• ISSN：1873-4626

文摘

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.