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01-12-2020 | Carcinoid Tumor | Stanford Multidisciplinary Seminars
Nearing the Summit: Associating Liver Partitioning and Portal Ligation for Staged Hepatectomy (ALPPS) in Progressive Carcinoid Disease
Published in: Digestive Diseases and Sciences | Issue 12/2020
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A 53-year-old woman was initially evaluated for abdominal discomfort and found to have bulky bilobar hepatic neuroendocrine tumor with unidentified primary. Biopsy of a liver lesion revealed well-differentiated neuroendocrine tumor, WHO G1, Ki-67 2% with mitotic rate 1/mm2. Since her tumor progressed during initial treatment with octreotide depot injections, she was switched to capecitabine/temozolomide, but again slowly progressed. After discussion in a multidisciplinary neuroendocrine tumor board, the decision was made to proceed with surgical resection. Her preoperative imaging (Fig. 1) showed bilobar disease with dominant masses abutting the right and left hepatic pedicles as well as the right and middle hepatic veins with the left hepatic vein free of tumor.
Fig. 1
Preoperative imaging of the liver at the level of the left portal vein (a, white arrow) and main portal vein (b, black arrow) demonstrates numerous arterially enhancing metastases involving segments 2, 3, 5, 6, 7, and 8. The metastases closely abut the vasculature
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