Laparoscopic debridement of hepatic necrosis after hepatic artery chemoembolization.
OBJECTIVE
Hepatic artery chemoembolization (HACE) used to treat neuroendocrine tumors metastatic to the liver has shown both survival benefit and improvement in symptoms. The development of hepatic necrosis after HACE is rare, but the consequences can be devastating. We report the first case of laparoscopic management of extensive hepatic necrosis occurring after HACE.


METHODS
A 58-year-old man with neuroendocrine tumor metastatic to the liver underwent HACE in addition to medical management. He had undergone previous biliary stenting for biliary obstruction. After HACE was performed via the right hepatic artery, the patient developed sepsis due to right hepatic lobe infarction. Percutaneous drainage and antibiotics were attempted for 2 months, but hepatic debridement was ultimately required due to repeated drain malfunction and septic complications. Laparoscopic necrosectomy was performed with ease and with little blood loss. The patient quickly recovered without any further infectious complications.


CONCLUSIONS
Infected hepatic necrosis resulting from HACE that fails percutaneous management can be successfully managed with laparoscopic necrosectomy. This report adds to the growing evidence that minimally invasive techniques can be used to manage complicated hepatic conditions.
Tejirian
Talar
T
Department of Surgery, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA, USA.
Heaney
Anthony
A
Colquhoun
Stephen
S
Nissen
Nicholas
N
D016461:Chemoembolization, Therapeutic / Q000009:adverse effects*; D003646:Debridement / Q000379:methods*; D006499:Hepatic Artery; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008099:Liver / Q000473:pathology*; D008113:Liver Neoplasms / Q000556:secondary / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009336:Necrosis / Q000601:surgery; D018358:Neuroendocrine Tumors / Q000556:secondary / Q000628:therapy*; D010166:Palliative Care; D010190:Pancreatic Neoplasms / Q000473:pathology