Hepatic Artery Embolization for Neuroendocrine Tumors: Postprocedural Management and Complications

• Published in: The oncologist (Dayton, Ohio) Ohio), 2012-05, Vol.17 (5), p.725-731
• Main Authors: Lewis, Mark A., Jaramillo, Sylvia, Roberts, Lewis, Fleming, Chad J., Rubin, Joseph, Grothey, Axel
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Embolization; Embolization, Therapeutic - adverse effects; Embolization, Therapeutic - methods; Female; Hepatic Artery; Humans; Liver metastasis; Liver Neoplasms - secondary; Liver Neoplasms - therapy; Male; Middle Aged; Neuroendocrine; Neuroendocrine Tumors - parasitology; Neuroendocrine Tumors - therapy; Practice improvement; Retrospective Studies; Symptom Management and Supportive Care
• ISSN: 1083-7159; 1549-490X
• DOI: 10.1634/theoncologist.2011-0372

Learning Objectives: After completing this course, the reader will be able to: Identify the components of the “postembolization syndrome”: elevated liver function tests, right upper quadrant pain, nausea and vomiting, and fever. Distinguish the postembolization syndrome from rare complications of embolization that would merit an extended hospitalization. This article is available for continuing medical education credit at CME.TheOncologist.com Background. There is scant evidence to guide the management of patients after hepatic artery embolization (HAE). We examined length of stay (LOS), laboratory patterns, medication usage, morbidity, and mortality of patients hospitalized after HAE for metastatic neuroendocrine tumors. Methods. Data were ed retrospectively from electronic medical records on LOS, liver function tests (LFTs), i.v. antibiotics, analgesia, peak temperature, bacteremia, hepatic abscess formation, carcinoid crisis, and metastatic burden on cross‐sectional imaging. Results. In 2005–2009, 72 patients underwent 174 HAEs for carcinoid and islet cell tumors. The median LOS was 4 days (range, 1–8 days). There was no correlation between peak LFTs and tumor burden. Declines in LFTs were not uniform before hospital discharge; 25%, 37%, 30%, 53%, and 67% of patients were discharged before their respective aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase, and total and direct bilirubin levels began to decline, with no readmissions for acute hepatic failure. The median i.v. analgesia dose was 60 mg oral morphine equivalents (range, 3–1,961 mg). Pre‐HAE i.v. antibiotics were administered in 99% of cases; post‐HAE fever occurred in 37% of patients, with no documented bacteremia. One patient developed a hepatic abscess after HAE. There were two carcinoid crises. The single in‐hospital death was associated with air in the portal veins. Conclusions. The duration and intensity of in‐hospital care following HAE should be managed on an individual basis. A downward trend in LFTs is not required before discharge. Modest use of i.v. analgesia suggests that many patients could exclusively receive oral analgesics. Given the rarity of serious complications, hospital stays could be shortened, thereby reducing costs and nosocomial risks. 摘要 背景。 关于肝动脉栓塞 （HAE） 患者的术后管理，目前还缺乏充足的证据指导。我们以 HAE 术后接受住院治疗的转移性神经内分泌肿瘤患者为目标人群，分析了他们的住院时间 （LOS）、检验结果、药物使用、病损率和死亡率。 方法。 我们从患者的电子病历中回顾性地收集了有关 LOS、肝功能检测 （LFT）、静脉抗生素使用、镇痛治疗、体温峰值、菌血症、肝脓肿形成、类癌危象和横断面成像所示转移灶负荷的数据。 结果。 在