RESUMO
BACKGROUND: Single institution reports demonstrate variable safety profiles when liver-directed therapy with Yttrium-90 (Y-90) is followed by hepatectomy. We hypothesized that in well-selected patients, hepatectomy after Y90 is feasible and safe. METHODS: Nine institutions contributed data for patients undergoing Y90 followed by hepatectomy (2008-2017). Clinicopathologic and perioperative data were analyzed, with 90-day morbidity and mortality as primary endpoints. RESULTS: Forty-seven patients were included. Median age was 59 (20-75) and 62% were male. Malignancies treated included hepatocellular cancer (n = 14; 30%), colorectal cancer (n = 11; 23%), cholangiocarcinoma (n = 8; 17%), neuroendocrine (n = 8; 17%) and other tumors (n = 6). The distribution of Y-90 treatment was: right (n = 30; 64%), bilobar (n = 14; 30%), and left (n = 3; 6%). Median future liver remnant (FLR) following Y90 was 44% (30-78). Resections were primarily right (n = 16; 34%) and extended right (n = 14; 30%) hepatectomies. The median time to resection from Y90 was 196 days (13-947). The 90-day complication rate was 43% and mortality was 2%. Risk factors for Clavien-Dindo Grade>3 complications included: number of Y-90-treated lobes (OR 4.5; 95% CI1.14-17.7; p = 0.03), extent of surgery (p = 0.04) and operative time (p = 0.009). CONCLUSIONS: These data demonstrate that hepatectomy following Y-90 is safe in well-selected populations. This multi-disciplinary treatment paradigm should be more widely studied, and potentially adopted, for patients with inadequate FLR.
Assuntos
Hepatectomia , Neoplasias Hepáticas/radioterapia , Neoplasias Hepáticas/cirurgia , Radioisótopos de Ítrio/uso terapêutico , Adulto , Idoso , Terapia Combinada , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos RetrospectivosRESUMO
PURPOSE: To prospectively evaluate percutaneous image-guided nerve cryoablation for treatment of refractory phantom limb pain (PLP) in a pilot cohort for purposes of deriving parameters to design a larger, randomized, parallel-armed, controlled trial. MATERIALS AND METHODS: From January 2015 to January 2016, 21 patients with refractory PLP underwent image-guided percutaneous cryoneurolysis procedures. Visual analog scale scores were documented at baseline and 7, 45, and 180 days after the procedure. Responses to a modified Roland Morris Disability Questionnaire were documented at baseline and 7 and 45 days after the procedure. RESULTS: Technical success rate of the procedures was 100%. There were 6 (29%) minor procedure-related complications. Disability scores decreased from a baseline mean of 11.3 to 3.3 at 45-day follow-up (95% confidence interval 5.8, 10.3; P < .0001). Pain intensity scores decreased from a baseline mean of 6.2 to 2.0 at long-term follow-up (95% confidence interval 2.8, 5.6; P < .0001). CONCLUSIONS: Image-guided percutaneous nerve cryoablation is feasible and safe and may represent a new efficacious therapeutic option for patients with phantom pains related to limb loss.
Assuntos
Amputados , Criocirurgia/métodos , Denervação/métodos , Sistema Nervoso Periférico/cirurgia , Membro Fantasma/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Amputados/psicologia , Criocirurgia/efeitos adversos , Denervação/efeitos adversos , Avaliação da Deficiência , Estudos de Viabilidade , Feminino , Georgia , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor , Percepção da Dor , Sistema Nervoso Periférico/fisiopatologia , Membro Fantasma/diagnóstico por imagem , Membro Fantasma/etiologia , Membro Fantasma/fisiopatologia , Projetos Piloto , Estudos Prospectivos , Inquéritos e Questionários , Fatores de Tempo , Tomografia Computadorizada por Raios X , Resultado do Tratamento , UltrassonografiaRESUMO
AIM: The aim of this study was to report a case of metastatic uveal melanoma in which radioembolized nodular liver metastases decreased in size while infiltrative sinusoidal metastases progressed, leading to jaundice without obstruction of the biliary ducts. METHODS: The relevant clinical features, imaging, and histopathologic findings of this case are reviewed. RESULTS: A 61-year-old Caucasian male with a history of uveal melanoma of the left eye status post plaque brachytherapy developed numerous liver metastases. After progression on systemic therapies, he underwent palliative radioembolization. Despite some radiographic improvement in the liver metastases, he developed hyperbilirubinemia without biliary tract obstruction or signs of liver failure. A biopsy of radiographically normal liver demonstrated extensive sinusoidal infiltration with melanoma. CONCLUSIONS: Distinct angiographic and histopathologic growth patterns of metastatic uveal melanoma differ in their amenability to radioembolization. Sinusoidal infiltration may lead to hyperbilirubinemia in the absence of overt obstruction or liver failure.
RESUMO
Primary and metastatic liver cancers are responsible for considerable morbidity and mortality, and many patients are not curable at presentation. Therefore, new therapies such as radioembolization with yttrium 90 ((90)Y)-labeled microspheres are an alternative method to treat patients with unresectable primary or secondary liver tumors. Patient selection, treatment technique, and early recognition of potential complications are the keys for successful patient outcomes. The activity of administered (90)Y microspheres depends on multiple variables, including the tumor burden, the volume of the liver lobe to be treated, the type of (90)Y microspheres, and the hepatopulmonary shunt fraction. Preprocedural planning relies on the results of cross-sectional imaging to determine the extent of disease, tumoral and nontumoral liver volumes, patency of the portal vein, and the degree of extrahepatic disease. A multidisciplinary approach that combines expertise in cross-sectional imaging, nuclear medicine, and flow dynamics is critical to adequately target malignant tissue. Preprocedural multimodality imaging, particularly combined single photon emission computed tomography (SPECT) and computed tomography (CT) imaging (SPECT/CT), may be used to identify nontarget imaging patterns that, if recognized, can potentially be corrected with either branch vessel embolization or catheter repositioning. Postprocedural multimodality imaging is also useful to confirm the appropriate delivery of (90)Y microspheres, enabling early identification of potential complications and the adequacy of microsphere distribution, thereby optimizing planning for subsequent therapies.
Assuntos
Angiografia/métodos , Braquiterapia/métodos , Embolização Terapêutica/métodos , Neoplasias Hepáticas/terapia , Imagem Multimodal/métodos , Radioterapia Guiada por Imagem/métodos , Radioisótopos de Ítrio/uso terapêutico , Terapia Combinada , Tomografia Computadorizada de Feixe Cônico , Vidro , Humanos , Injeções Intra-Arteriais , Comunicação Interdisciplinar , Resinas de Troca Iônica , Fígado/efeitos da radiação , Neoplasias Hepáticas/irrigação sanguínea , Neoplasias Hepáticas/diagnóstico por imagem , Neoplasias Hepáticas/radioterapia , Neoplasias Hepáticas/secundário , Imageamento por Ressonância Magnética/métodos , Microesferas , Cuidados Pré-Operatórios , Tolerância a Radiação , Compostos de Sulfidrila , Agregado de Albumina Marcado com Tecnécio Tc 99m , Distribuição Tecidual , Tomografia Computadorizada de Emissão de Fóton Único/métodos , Radioisótopos de Ítrio/administração & dosagem , Radioisótopos de Ítrio/farmacocinéticaRESUMO
Primary omental torsion is an uncommon cause of an acute abdomen that can mimic acute appendicitis. Herein we report a case of suspected acute appendicitis that proved to be a distal segment of infarcted omentum secondary to primary torsion.