Transcatheter chemoembolization of progressive carcinoid liver metastasis.

PURPOSE: The authors report their experience treating progressive liver metastases from carcinoid tumor with doxorubicin, iodized oil, and gelatin sponge embolization. MATERIALS AND METHODS: Of 23 patients, 18 had carcinoid syndrome and 19 had elevated urinary 5-hydroxyindoleacetic acid (5-HIAA) levels. Relief of symptoms, changes in 5-HIAA levels, and changes in tumor size could be evaluated in 10, 11, and 17 patients, respectively. RESULTS: Symptomatic response was complete (average duration, 29 months) in 70% and partial in 30% of evaluated patients. Biologic response was complete (average duration, 21 months) in 73%, partial in 18%, and minor in 9% of evaluated patients. Morphologic response was complete in 11%, partial in 24%, and minor in 24% of evaluated patients. Survival after diagnosis of primary tumor, diagnosis of hepatic metastases, and first chemoembolization was 81, 47, and 24 months, respectively. Eight patients were alive at the end of the study. No mortality was related to chemoembolization. CONCLUSION: Chemoembolization is safe and effective for palliation of carcinoid liver metastases.

Portal vein embolization: utility for inducing left hepatic lobe hypertrophy before surgery.

Right portal vein embolization (PVE) was performed in patients in need of wide hepatectomy to induce preoperative hypertrophy of the future remnant liver (FRL), which would have been insufficient for safe resection. PVE was achieved with cyanoacrylate or gelatin sponges by using a percutaneous subxiphoid approach in 10 patients with tumors in noncirrhotic liver. Surgery was performed in nine patients 17-48 days (mean, 34 days) after PVE. Computed tomographic liver volumetric studies were performed before embolization and before surgery. Clinical and biologic tolerance of PVE was excellent except in one case. Histopathologic studies showed occlusion of portal veins with minimal parenchymal ischemia in eight of nine patients. The FRL volume increased by 64%, which represented 31% of the preresection volume of the liver. Better hypertrophy was seen after cyanoacrylate embolization. The authors conclude that PVE is safe and well tolerated and induces marked hypertrophy of the unembolized parenchyma in noncirrhotic patients. This hypertrophy allows hepatectomy to be performed under safe conditions when the FRL volume is initially insufficient.

[Percutaneous metallic biliary prosthesis]. / Prothèses biliaires métalliques percutanées.

Two types of metallic endoprostheses may be placed via a transhepatic approach: 1) self expandable stents which open by themselves as soon as they are released from the carrier system, 2) balloon expandable stents which need to be dilated by a balloon catheter at the time of deployment. Gianturco and Wallstent endoprostheses belong to the first group and are most often used. The fenestrated wall of metallic endoprostheses preserves the patency of bile ducts joining the stented segment, which is a major advantage for hilar and intra-hepatic stenosis. Their design allows the endoprostheses to be incorporated into the bile duct wall, minimising biliary encrustation and leaving a wider internal lumen as compared to plastic stents. On the other hand, tumor ingrowth in the stented segment is possible and parietal incorporation makes the stent nonretrievable after a few weeks. A favorable indication is therefore extrinsic compression, especially in hilar and intra-hepatic segments. Whatever the indications, metallic stenting has an advantage in the treatment of biliary stenosis, either benign or malignant, owing to less traumatic positioning while their patency rate remains high.