title: Emergency therapy for liver metastases from advanced VIPoma: surgery or transarterial chemoembolization?
abstract: VIPoma is a rare neuroendocrine tumor (NET) with a high potential to develop hepatic metastases and poor prognosis. The primitive tumor is nonsymptomatic and usually localized within the pancreas. Liver metastasis drives the prognosis and induces profuse watery diarrhea or renal failure. We herein present severe renal failure or diarrhea in two patients hospitalized in intensive care justifying emergency treatment of liver metastasis. The two patients experienced severe diarrhea due to a hypersecretion of vasoactive intestinal peptide (VIP) from liver metastasis released into the blood circulation. Therapeutic management was discussed and liver transarterial chemoembolization (TACE) was performed with chemotherapy-loaded embospheres, which cause necrosis of tumor lesions. TACE controlled the hormonal syndrome and made patients eligible for curative surgery. Tumor necrosis occurred and VIP levels collapsed. Surgery was performed in one of the two cases after TACE and the patient was considered in remission. Both patients were still alive after 3 years of follow up. Thus, TACE is feasible and appears to be an effective emergency treatment in patients with a VIP-hormonal syndrome due to liver metastases. Despite the biological disorder due to the hormonal secretion, an aggressive approach is warranted in VIP liver metastasis.
authors: Gastroenterology and Endoscopy Unit, Hôpital Cochin, 27, Rue du Faubourg, Saint Jacques F75014, Paris, France.
authors: Johann
authors: J
authors: Dréanic
authors: Department of Digestive Oncology, Hôpital Européen Georges Pompidou, Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, AP-HP, Paris, France.
authors: Céline
authors: C
authors: Lepère
authors: Department of Radiology, Hôpital Ambroise Paré, Université Paris Ouest Versailles, AP-HP, Boulogne, France.
authors: Mostafa
authors: M
authors: El Hajjam
authors: Department of Radiology, Hôpital Cochin, Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, AP-HP, Paris, France.
authors: Hervé
authors: H
authors: Gouya
authors: Department of Digestive Oncology, Hôpital Européen Georges Pompidou, Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, AP-HP, Paris, France.
authors: Philippe
authors: P
authors: Rougier
authors: Department of Gastroenterology and Endoscopy, Hôpital Cochin, Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, AP-HP, Paris, France.
authors: Romain
authors: R
authors: Coriat
keywords: VIPoma; hepatectomy; neuroendocrine tumors (NET); systemic chemotherapy; transarterial chemo embolization (TACE); vasoactive intestinal peptide (VIP)