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Salvage Hepatectomy for Giant GIST Liver Metastases Unresponsive to Systemic Therapy—Case Report

Therapeutic decision-making for advanced GIST liver metastases is challenging due to limited clinical evidence. This case study aims to demonstrate the survival benefit of resection in non-responsive cases. A 40-year-old male presented with abdominal pain, weight loss, altered general status, massiv...

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Autores principales: Kraft, Alin, Moldovan, Cosmin, Bârcu, Alexandru, Dumitru, Radu, Croitoru, Adina, Herlea, Vlad, Popescu, Irinel, Botea, Florin
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10456077/
https://www.ncbi.nlm.nih.gov/pubmed/37629538
http://dx.doi.org/10.3390/life13081681
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author Kraft, Alin
Moldovan, Cosmin
Bârcu, Alexandru
Dumitru, Radu
Croitoru, Adina
Herlea, Vlad
Popescu, Irinel
Botea, Florin
author_facet Kraft, Alin
Moldovan, Cosmin
Bârcu, Alexandru
Dumitru, Radu
Croitoru, Adina
Herlea, Vlad
Popescu, Irinel
Botea, Florin
author_sort Kraft, Alin
collection PubMed
description Therapeutic decision-making for advanced GIST liver metastases is challenging due to limited clinical evidence. This case study aims to demonstrate the survival benefit of resection in non-responsive cases. A 40-year-old male presented with abdominal pain, weight loss, altered general status, massive hepatomegaly, and intermittent melaena. He was diagnosed with stage IV GIST with the primary tumor in the ileal loop and multiple gigantic synchronous bilobar liver metastases. Despite 31 months of tyrosine-kinase inhibitor therapy post-primary tumor resection, the disease remained unresponsive. The patient was admitted to our tertiary center with significant hepatomegaly. A two-stage debulking liver resection was performed after a multidisciplinary team decision. The first operation debulked the left hemiliver through a non-anatomical ultrasound-guided resection of segments 2, 3, and 4. The second operation (7 weeks later) debulked the right hemiliver through a right posterior sectionectomy involving segments 5 and 8. Despite receiving a second line of tyrosine-kinase inhibitor therapy after surgery, the disease progressed both within and outside the liver. However, the patient survived for 55 months, with a postoperative survival benefit of 25 months. In conclusion, this case emphasizes the significant survival benefit achieved through a complex two-stage debulking liver resection for giant liver metastases, even in cases where systemic therapy fails.
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spelling pubmed-104560772023-08-26 Salvage Hepatectomy for Giant GIST Liver Metastases Unresponsive to Systemic Therapy—Case Report Kraft, Alin Moldovan, Cosmin Bârcu, Alexandru Dumitru, Radu Croitoru, Adina Herlea, Vlad Popescu, Irinel Botea, Florin Life (Basel) Case Report Therapeutic decision-making for advanced GIST liver metastases is challenging due to limited clinical evidence. This case study aims to demonstrate the survival benefit of resection in non-responsive cases. A 40-year-old male presented with abdominal pain, weight loss, altered general status, massive hepatomegaly, and intermittent melaena. He was diagnosed with stage IV GIST with the primary tumor in the ileal loop and multiple gigantic synchronous bilobar liver metastases. Despite 31 months of tyrosine-kinase inhibitor therapy post-primary tumor resection, the disease remained unresponsive. The patient was admitted to our tertiary center with significant hepatomegaly. A two-stage debulking liver resection was performed after a multidisciplinary team decision. The first operation debulked the left hemiliver through a non-anatomical ultrasound-guided resection of segments 2, 3, and 4. The second operation (7 weeks later) debulked the right hemiliver through a right posterior sectionectomy involving segments 5 and 8. Despite receiving a second line of tyrosine-kinase inhibitor therapy after surgery, the disease progressed both within and outside the liver. However, the patient survived for 55 months, with a postoperative survival benefit of 25 months. In conclusion, this case emphasizes the significant survival benefit achieved through a complex two-stage debulking liver resection for giant liver metastases, even in cases where systemic therapy fails. MDPI 2023-08-03 /pmc/articles/PMC10456077/ /pubmed/37629538 http://dx.doi.org/10.3390/life13081681 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Case Report
Kraft, Alin
Moldovan, Cosmin
Bârcu, Alexandru
Dumitru, Radu
Croitoru, Adina
Herlea, Vlad
Popescu, Irinel
Botea, Florin
Salvage Hepatectomy for Giant GIST Liver Metastases Unresponsive to Systemic Therapy—Case Report
title Salvage Hepatectomy for Giant GIST Liver Metastases Unresponsive to Systemic Therapy—Case Report
title_full Salvage Hepatectomy for Giant GIST Liver Metastases Unresponsive to Systemic Therapy—Case Report
title_fullStr Salvage Hepatectomy for Giant GIST Liver Metastases Unresponsive to Systemic Therapy—Case Report
title_full_unstemmed Salvage Hepatectomy for Giant GIST Liver Metastases Unresponsive to Systemic Therapy—Case Report
title_short Salvage Hepatectomy for Giant GIST Liver Metastases Unresponsive to Systemic Therapy—Case Report
title_sort salvage hepatectomy for giant gist liver metastases unresponsive to systemic therapy—case report
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10456077/
https://www.ncbi.nlm.nih.gov/pubmed/37629538
http://dx.doi.org/10.3390/life13081681
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