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Number of Local Regional Therapies for Hepatocellular Carcinoma and Peri-Operative Outcomes after Liver Transplantation. Cancers (Basel) 2023; 15:cancers15030620. [PMID: 36765576 PMCID: PMC9913666 DOI: 10.3390/cancers15030620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 01/12/2023] [Accepted: 01/17/2023] [Indexed: 01/20/2023] Open
Abstract
The wait times for patients with hepatocellular carcinoma (HCC) listed for liver transplant are longer than ever, which has led to an increased reliance on the use of pre-operative LRTs. The impact that multiple rounds of LRTs have on peri-operative outcomes following transplant is unknown. This was a retrospective single center analysis of 298 consecutive patients with HCC who underwent liver transplant (January 2017 to May 2021). The data was obtained from two institution-specific databases and the TransQIP database. Of the 298 patients, 27 (9.1%) underwent no LRTs, 156 (52.4%) underwent 1-2 LRTs, and 115 (38.6%) underwent ≥3 LRTs prior to LT. The patients with ≥3 LRTs had a significantly higher rate of bile leak compared to patients who received 1-2 LRTs (7.0 vs. 1.3%, p = 0.014). Unadjusted and adjusted regression analyses demonstrated a significant association between the total number of LRTs administered and bile leak, but not rates of overall biliary complications. The total number of LRTs was not significantly associated with any other peri-operative or post-operative outcome measure. These findings support the aggressive use of LRTs to control HCC in patients awaiting liver transplant, with further evaluation needed to confirm the biliary leak findings.
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Hall AD, White SB, Rilling WS. Biliary-Caval Fistula following Y90 Radioembolization. Semin Intervent Radiol 2021; 38:488-491. [PMID: 34629719 DOI: 10.1055/s-0041-1735605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The safety of radioembolization with yttrium-90 ( 90 Y) is well documented and major complications are rare. Previous studies have demonstrated that biliary complications following 90 Y, including bile duct injury and hepatic abscess formation, occur at an increased rate in patients who have had prior biliary surgery and interventions. This article reviews a case of a patient who developed recurrent cholangitis and sepsis as well as a biliary-caval fistula following radioembolization. Additionally, we review current data regarding biliary complications following radioembolization in patients with prior biliary intervention.
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Affiliation(s)
- Alexander D Hall
- Division of Vascular and Interventional Radiology, Department of Radiology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Sarah B White
- Division of Vascular and Interventional Radiology, Department of Radiology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - William S Rilling
- Division of Vascular and Interventional Radiology, Department of Radiology, Medical College of Wisconsin, Milwaukee, Wisconsin
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Early Presentation of Septic Shock Secondary to Infection of the Treatment Zone Following Radioembolization for Hepatocellular Carcinoma. Cardiovasc Intervent Radiol 2020; 43:1105-1107. [DOI: 10.1007/s00270-020-02466-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 03/24/2020] [Indexed: 11/26/2022]
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Seo SK, Gedrimaite Z, Fleischer D, Cohen N, Petre E, Brown KT, Covey A. Impact of Eliminating Postprocedural Antibiotic Prophylaxis in Patients without Biliary Instrumentation or Bypass Undergoing Hepatic Artery Embolization for Hepatic Malignancies. J Vasc Interv Radiol 2019; 30:1895-1900. [PMID: 31668968 DOI: 10.1016/j.jvir.2019.07.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 07/12/2019] [Accepted: 07/20/2019] [Indexed: 11/29/2022] Open
Abstract
PURPOSE To assess the infection rate after eliminating postprocedural antibiotics in patients undergoing hepatic artery embolization (HAE) for primary and secondary hepatic malignancies. MATERIAL AND METHODS In this historical cohort study, adults ≥18 years of age without prior biliary instrumentation or bypass who underwent HAE and received pre- and postprocedure antibiotic prophylaxis between September 1, 2014, and August 31, 2015, comprised group A, whereas similar patients receiving only preprocedure antibiotic prophylaxis between October 1, 2015, and September 30, 2016, comprised group B. Procedures conducted between September 1, 2015, and September 30, 2015, were excluded. The primary outcome was any infection occurring within 30 days of HAE. RESULTS A total of 150 patients underwent 204 HAE procedures in group A, and 171 patients underwent 221 procedures in group B. Cefazolin given as a 1-g dose (or 2 grams if obese) was administered in 391 of 425 evaluable procedures (92%). Clindamycin plus gentamicin was prescribed in 34 patients (8%) who had severe penicillin allergy. There was significant improvement in adherence to the postprocedure antibiotic regimen, from 68% (138 of 204 procedures) to 98% (216 of 221 procedures) (P < .001) with elimination of postprocedure prophylaxis. There were no significant differences in 30-day infection rates (5 [3%] vs. 5 [2%]; P = .57), hospital readmissions (13 [6%] vs. 12 [5%]; P = .68), or all-cause mortality (3 [1%] vs. 3 [1%]; P = .62) between the 2 groups. CONCLUSIONS Elimination of postprocedural antibiotics after HAE did not lead to an increase in infectious complications. This finding supports the 2018 Society of Interventional Radiology recommendation for preprocedural prophylaxis only for HAE in the setting of an intact sphincter of Oddi.
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Affiliation(s)
- Susan K Seo
- Infectious Disease Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Medicine, Weill Cornell Medical College, New York, New York.
| | - Zivile Gedrimaite
- Infectious Disease Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Deborah Fleischer
- Interventional Radiology Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Nina Cohen
- Department of Pharmacy, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Elena Petre
- Interventional Radiology Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Karen T Brown
- Interventional Radiology Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Radiology, Weill Cornell Medical College, New York, New York
| | - Anne Covey
- Interventional Radiology Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Radiology, Weill Cornell Medical College, New York, New York
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Devulapalli KK, Fidelman N, Soulen MC, Miller M, Johnson MS, Addo E, El-Haddad G, Nutting C, Morrison J, Farsad K, Lokken RP, Gaba RC, Fleming J, Brown DB, Kwan SW, Rose SC, Pennycooke KA, Liu DM, White SB, Gandhi R, Lazar AA, Kerlan RK. 90Y Radioembolization for Hepatic Malignancy in Patients with Previous Biliary Intervention: Multicenter Analysis of Hepatobiliary Infections. Radiology 2018; 288:774-781. [DOI: 10.1148/radiol.2018170962] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Huang SY, Philip A, Richter MD, Gupta S, Lessne ML, Kim CY. Prevention and management of infectious complications of percutaneous interventions. Semin Intervent Radiol 2015; 32:78-88. [PMID: 26038616 DOI: 10.1055/s-0035-1549372] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Infectious complications following interventional radiology (IR) procedures can cause significant patient morbidity and, potentially, mortality. As the number and breadth of IR procedures grow, it becomes increasingly evident that interventional radiologists must possess a thorough understanding of these potential infectious complications. Furthermore, given the increasing incidence of antibiotic-resistant bacteria, emphasis on cost containment, and attention to quality of care, it is critical to have infection control strategies to maximize patient safety. This article reviews infectious complications associated with percutaneous ablation of liver tumors, transarterial embolization of liver tumors, uterine fibroid embolization, percutaneous nephrostomy, percutaneous biliary interventions, central venous catheters, and intravascular stents. Emphasis is placed on incidence, risk factors, prevention, and management. With the use of these strategies, IR procedures can be performed with reduced risk of infectious complications.
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Affiliation(s)
- Steven Y Huang
- Department of Interventional Radiology, The University of Texas, MD Anderson Cancer Center, Houston, Texas
| | - Asher Philip
- Department of Interventional Radiology, The University of Texas, MD Anderson Cancer Center, Houston, Texas
| | - Michael D Richter
- Department of Interventional Radiology, The University of Texas, MD Anderson Cancer Center, Houston, Texas
| | - Sanjay Gupta
- Department of Interventional Radiology, The University of Texas, MD Anderson Cancer Center, Houston, Texas
| | - Mark L Lessne
- Vascular and Interventional Specialists of Charlotte Radiology, Charlotte, North Carolina
| | - Charles Y Kim
- Division of Vascular and Interventional Radiology, Duke University Medical Center, Durham, North Carolina
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Korkmaz M, Bozkaya H, Çınar C, Şanal B, Güneyli S, Parıldar M, Oran İ. Liver abscess following radioembolization with yttrium-90 microspheres. Wien Klin Wochenschr 2014; 126:785-8. [DOI: 10.1007/s00508-014-0609-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Accepted: 08/29/2014] [Indexed: 11/29/2022]
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Cholapranee A, van Houten D, Deitrick G, Dagli M, Sudheendra D, Mondschein JI, Soulen MC. Risk of liver abscess formation in patients with prior biliary intervention following yttrium-90 radioembolization. Cardiovasc Intervent Radiol 2014; 38:397-400. [PMID: 24989145 DOI: 10.1007/s00270-014-0947-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2013] [Accepted: 06/08/2014] [Indexed: 01/14/2023]
Abstract
PURPOSE Patients without a competent sphincter of Oddi due to prior surgical or endoscopic therapy are at high risk for liver abscess following chemoembolization despite aggressive antimicrobial prophylaxis. We examined a cohort of such patients undergoing Y-90 resin radioembolization and compared them to a cohort of chemoembolized patients. METHODS Review of our quality-assurance database identified 24 radioembolizations performed in 16 patients with prior biliary intervention. An aggressive prophylactic regimen of oral levofloxacin and metronidazole 2 days pre-procedure continuing for 14 days after, oral neomycin/erythromycin bowel prep the day before, and IV levofloxacin/metronidazole the day of treatment was prescribed. Patients underwent resin microsphere radioembolization dosed according to the BSA method. Patients had clinical, imaging, and laboratory assessment 1 month after each treatment, and then every 3 months. The chemoembolization cohort consisted of 13 patients with prior biliary intervention who had undergone 24 chemoembolization procedures. RESULTS No radioembolization patient developed an abscess. In the cohort of chemoembolized patients who received the same prophylaxis, liver abscess occurred following 3 of 24 (12.5 %) procedures in 3 of 13 (23 %) patients, one fatal. CONCLUSIONS This preliminary experience suggests that the risk of liver abscess among patients with prior biliary intervention may be lower following radioembolization than chemoembolization, which could potentially expand treatment options in this high-risk population.
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Affiliation(s)
- Aurada Cholapranee
- Division of Interventional Radiology, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, 19104, USA
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Michl M, Haug AR, Jakobs TF, Paprottka P, Hoffmann RT, Bartenstein P, Boeck S, Haas M, Laubender RP, Heinemann V. Radioembolization with Yttrium-90 microspheres (SIRT) in pancreatic cancer patients with liver metastases: efficacy, safety and prognostic factors. Oncology 2013; 86:24-32. [PMID: 24401529 DOI: 10.1159/000355821] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2013] [Accepted: 09/13/2013] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To analyze the clinical efficacy of (90)Y radioembolization in liver metastases from pancreatic cancer, to describe treatment toxicities and to identify biomarkers as predictors of outcome. METHODS Data from 19 pancreatic cancer patients (9 females/10 males) who had received (90)Y radioembolization for metastatic liver disease between 06/2004 and 01/2011 were analyzed retrospectively. RESULTS The median age at (90)Y radioembolization was 63 years (range 43-77). In 16 patients, previous palliative gemcitabine-based chemotherapy was given for metastatic disease. Objective response in the liver after (90)Y radioembolization was 47%. Median local progression-free survival in the liver was 3.4 months (range 0.9-45.0). Median overall survival (OS) was 9.0 months (range 0.9-53.0) and 1-year survival was 24%. Cox regression models for baseline biomarkers at (90)Y radioembolization revealed correlations of increased carbohydrate antigen 19-9 (p = 0.02) and C-reactive protein (p = 0.03) with shorter OS. Short-term adverse events (nausea, vomiting, fatigue, fever and abdominal pain) did not exceed grade 3. As long-term adverse events, liver abscesses, gastroduodenal ulceration, cholestasis and cholangitis, ascites and spleen infarction were observed. CONCLUSION (90)Y radioembolization is able to induce an encouraging local response rate of liver metastases of pancreatic cancer patients. Most short-term toxicities are manageable; however, patients should be followed up carefully for severe long-term toxicities.
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Affiliation(s)
- M Michl
- Department of Medical Oncology, Klinikum Grosshadern and Comprehensive Cancer Center, Munich, Germany
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Abstract
Pancreatic neuroendocrine tumors (pancreatic NETs) are rare, low- to intermediate-grade neoplasms thought to arise from the pancreatic islets. Recent advances in pathology and our understanding of the biological behavior of this group of tumors has resulted in changes in their nomenclature and how we treat them. This review puts into perspective our current understanding of pancreatic NETs in terms of their incidence, pathology, and management.
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Mascarenhas N, Ryu RK, Salem R. Hepatic radioembolization complicated by abscess. Semin Intervent Radiol 2012; 28:222-5. [PMID: 22654267 DOI: 10.1055/s-0031-1280669] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Hepatic abscess is a rare complication of yttrium-90 radioembolization of hepatic tumors that most commonly occurs in patients with a history of biliary intervention. Patients usually present several weeks after therapy with pain, nausea, vomiting, and fever. Cross-sectional imaging is necessary in cases of suspected abscess to ensure prompt diagnosis and to help plan treatment, which involves antibiotics and percutaneous drainage.
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Affiliation(s)
- Neil Mascarenhas
- Department of Radiology - Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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Practice Guideline for Adult Antibiotic Prophylaxis during Vascular and Interventional Radiology Procedures. J Vasc Interv Radiol 2010; 21:1611-30; quiz 1631. [DOI: 10.1016/j.jvir.2010.07.018] [Citation(s) in RCA: 302] [Impact Index Per Article: 21.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2010] [Revised: 07/03/2010] [Accepted: 07/23/2010] [Indexed: 12/11/2022] Open
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