title: A rare surgical case of multiple liver resections for recurrent liver metastases from pancreatic gastrinoma: liver and vena cava resection.
abstract: Pancreatic gastrinoma is a rare non-beta islet cell tumor. Approximately 60% of gastrinomas are malignant; despite the fact that they are usually slow growing, liver metastases have a major impact on prognosis. Most authors have advocated aggressive surgical management as being the only potentially curative therapy to improve survival as well as to provide outstanding relief from symptoms. We present a case of a 57-year-old man referred to our hospital with a diagnosis of liver metastases from pancreatic gastrinoma, with suspected involvement of the inferior vena cava (IVC). At the age of 37 years, he was diagnosed in his local hospital as having a pancreatic gastrinoma, with liver metastases, and he underwent distal pancreatectomy, splenectomy and enucleation of liver metastases. A liver tumor recurred twice, 7 and 9 years after the first surgery, for which double liver resections were performed: the first time he underwent enucleation of multiple liver metastases in segments II, III, IV, V, VI, VII and VIII, with resection of the right hepatic vein and partially resection of the diaphragm; the second time he underwent enucleation of multiple liver metastases in segments II, III, IV, and V. In our hospital, 8 years after the last surgery, the patient underwent right extended trisectionectomy, resection of segment I, combined resection of the IVC, and partial removal of the diaphragm. To the best of our knowledge, from a review of the literature, this is the first case to achieve successful long-term survival through aggressive surgical management of this type of metastatic endocrine tumor. The patient described here is still alive, free of disease and leading a normal life, 20 years after the initial diagnosis and 3 years after the last surgery.
authors.affiliation: Division of Surgical Oncology, Department of Surgery, Graduate School of Medicine, University of Nagoya, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan.
authors.forename: Silvia
authors.initials: S
authors.lastname: Pachera
authors.forename: Yukihiro
authors.initials: Y
authors.lastname: Yokoyama
authors.forename: Hideki
authors.initials: H
authors.lastname: Nishio
authors.forename: Koji
authors.initials: K
authors.lastname: Oda
authors.forename: Tomoki
authors.initials: T
authors.lastname: Ebata
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Igami
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Abe
authors.forename: Yuji
authors.initials: Y
authors.lastname: Shingu
authors.forename: Masato
authors.initials: M
authors.lastname: Nagino
mesh_terms: D001707:Biopsy, Needle; D005500:Follow-Up Studies; D015408:Gastrinoma / Q000473:pathology / Q000556:secondary* / Q000601:surgery; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D007150:Immunohistochemistry; D008113:Liver Neoplasms / Q000556:secondary / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology / Q000601:surgery*; D009367:Neoplasm Staging; D010190:Pancreatic Neoplasms / Q000473:pathology* / Q000601:surgery; D010690:Phlebography; D035583:Rare Diseases; D012086:Reoperation; D018570:Risk Assessment; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000379:methods; D014682:Vena Cava, Inferior / Q000473:pathology / Q000601:surgery*