Two-stage resection of the liver in patients with neuroendocrine tumor metastases. A case report

Kolesnik O.O., Lukashenko A., Zubarev M.H., Ostapenko U.V.

Summary. Over the last decades the incidence of neuroendocrine tumors (NETs) has been slightly increased to 3 per 100,000 population per year. There are some factors such as the stage of the disease, the presence of carcinoid syndrome, the degree of differentiation, indicators of the proliferation index of Ki-67 considerably influence the outcomes of the treatment. Introducing of the combine methods significantly improves overall survival of the patients with NET liver metastases as to 80–120 months. The main problem of the liver surgery is the inadequate future remnant liver volume. Ligation of the portal vein branches can improve the remnant liver volume. 55-year-old female was found to have metachronous multiple metastases in the liver after successful treatment of NET of small intestine in 2009 (T3N0M0 G1) Ki-67 <3%. The remnant liver volume was insufficient <30%. Two-stage resection of the liver with the ligation of the portal vein branches was performed: stage 1 — bisegmentectomy of II–III segments and selective ligation of the portal vein branches of the rear section. CT volumetry within 1 month revealed 56% of the hypertrophy of the liver parenchyma in the contrаlateral lobe. Stage 2 — rear right sectorectomy (VI–VII segments). There were no postoperative complications. At present, a patient shows stable remission without any signs of the disease prolongation. The results of the clinical case proved the efficacy and safety of the two-stage liver resection with the ligation of the portal vein branches providing sufficient remnant liver volume and helping to avoid unnecessary diverse postoperative complications in patients with NET liver metastases.
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