Document Detail


Living donor liver transplantation combined with Whipple's procedure for metastatic gastrinoma: a clinical case with 5 years follow-up.
MedLine Citation:
PMID:  19803263     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
INTRODUCTION: Most patients with gastro-enteropancreatic neuro-endocrine tumours present with liver metastases at the time of diagnosis. As metastases are usually widespread in the liver, though remain confined to this organ for long periods of time, liver transplantation could be in some cases a possible treatment option. MATERIAL AND METHODS: We herein report the case of a 24-year-old male with Zollinger-Ellison syndrome, who was referred to our department after having had a right hepatectomy for metastatic lesions, followed by chemotherapy. At that time, the site of the primary tumour was undefined. Following the diagnosis of a primary gastrinoma in the pancreatic head after selective angiography of the pancreatic vessels with hormonal sampling tests in our institution, the decision was made to offer a living donor liver transplantation (LDLT). RESULTS: A right lobe LDLT was carried out together with a Whipple's procedure. The operation was uneventful and five years later the patient remains in an excellent clinical condition, although with a suspicion of relapsed gastrinoma. DISCUSSION: According to the literature, some conditions, such as the 1-step combined surgery, gastrinoma primary tumour and duodeno-pancreatical localisation are considered as poor prognostic factors, whereas young age and tumour expression of Ki-67 < 5% are linked to a more favourable outcome. We think that in cases of long-lasting stability of the disease under chemotherapy, together with the presence of a low Ki-67 expression index, such a treatment could be proposed to young and symptomatic patients, provided the resection of the primary tumour is feasible. Long-term survival may be achieved in metastatic gastro-enteropancreatic neuro-endocrine tumours after LDLT combined with Whipple's procedure, despite tumour relapse.
Authors:
L E Abreu de Carvalho; R Troisi; B de Hemptinne
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Publication Detail:
Type:  Case Reports; Journal Article    
Journal Detail:
Title:  Acta chirurgica Belgica     Volume:  109     ISSN:  0001-5458     ISO Abbreviation:  Acta Chir. Belg.     Publication Date:    2009 Jul-Aug
Date Detail:
Created Date:  2009-10-06     Completed Date:  2009-10-22     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0370571     Medline TA:  Acta Chir Belg     Country:  Belgium    
Other Details:
Languages:  eng     Pagination:  498-500     Citation Subset:  IM    
Affiliation:
Department of General and Hepato-Biliary Surgery, Liver Transplantation Service, Ghent University Hospital Medical School, Belgium.
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MeSH Terms
Descriptor/Qualifier:
Digestive System Surgical Procedures*
Follow-Up Studies
Gastrinoma / secondary,  surgery*
Hepatectomy
Humans
Liver Neoplasms / surgery*
Liver Transplantation* / methods
Living Donors
Male
Pancreatic Neoplasms / secondary,  surgery*
Young Adult
Zollinger-Ellison Syndrome / surgery*

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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