Hepatic artery embolization for neuroendocrine tumors

Postprocedural management and complications

Mark A. Lewis, Sylvia Jaramillo, Lewis Rowland Roberts, Chad J. Fleming, Joseph Rubin, Axel F Grothey

Research output: Contribution to journalArticle

17 Citations (Scopus)

Abstract

Background. There is scant evidence to guide the management of patients after hepatic artery embolization (HAE). We examined length of stay (LOS), laboratory patterns, medication usage, morbidity, and mortality of patients hospitalized after HAE for metastatic neuroendocrine tumors. Methods. Data were abstracted retrospectively from electronic medical records on LOS, liver function tests (LFTs), i.v. antibiotics, analgesia, peak temperature, bacteremia, hepatic abscess formation, carcinoid crisis, and metastatic burden on cross-sectional imaging. Results. In 2005-2009, 72 patients underwent 174 HAEs for carcinoid and islet cell tumors. The median LOS was 4 days (range, 1-8 days). There was no correlation between peak LFTs and tumor burden. Declines in LFTs were not uniform before hospital discharge; 25%, 37%, 30%, 53%, and 67% of patients were discharged before their respective aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase, and total and direct bilirubin levels began to decline, with no readmissions for acute hepatic failure. The median i.v. analgesia dose was 60 mg oral morphine equivalents (range, 3-1,961 mg). Pre-HAE i.v. antibiotics were administered in 99% of cases; post-HAE fever occurred in 37% of patients, with no documented bacteremia. One patient developed a hepatic abscess after HAE. There were two carcinoid crises. The single in-hospital death was associated with air in the portal veins. Conclusions. The duration and intensity of in-hospital care following HAE should be managed on an individual basis. A downward trend in LFTs is not required before discharge. Modest use of i.v. analgesia suggests that many patientscould exclusively receive oralanalgesics. Given the rarity of serious complications, hospital stays could be shortened, thereby reducing costs and nosocomial risks.

Original languageEnglish (US)
Pages (from-to)725-731
Number of pages7
JournalOncologist
Volume17
Issue number5
DOIs
StatePublished - 2012

Fingerprint

Neuroendocrine Tumors
Hepatic Artery
Liver Function Tests
Length of Stay
Carcinoid Tumor
Analgesia
Liver Abscess
Bacteremia
Islet Cell Adenoma
Anti-Bacterial Agents
Acute Liver Failure
Electronic Health Records
Aspartate Aminotransferases
Portal Vein
Tumor Burden
Alanine Transaminase
Bilirubin
Morphine
Alkaline Phosphatase
Fever

Keywords

  • Embolization
  • Liver metastasis
  • Neuroendocrine
  • Practice improvement

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

Hepatic artery embolization for neuroendocrine tumors : Postprocedural management and complications. / Lewis, Mark A.; Jaramillo, Sylvia; Roberts, Lewis Rowland; Fleming, Chad J.; Rubin, Joseph; Grothey, Axel F.

In: Oncologist, Vol. 17, No. 5, 2012, p. 725-731.

Research output: Contribution to journalArticle

Lewis, Mark A. ; Jaramillo, Sylvia ; Roberts, Lewis Rowland ; Fleming, Chad J. ; Rubin, Joseph ; Grothey, Axel F. / Hepatic artery embolization for neuroendocrine tumors : Postprocedural management and complications. In: Oncologist. 2012 ; Vol. 17, No. 5. pp. 725-731.
@article{073fc345f26c46959363e4d4eef84326,
title = "Hepatic artery embolization for neuroendocrine tumors: Postprocedural management and complications",
abstract = "Background. There is scant evidence to guide the management of patients after hepatic artery embolization (HAE). We examined length of stay (LOS), laboratory patterns, medication usage, morbidity, and mortality of patients hospitalized after HAE for metastatic neuroendocrine tumors. Methods. Data were abstracted retrospectively from electronic medical records on LOS, liver function tests (LFTs), i.v. antibiotics, analgesia, peak temperature, bacteremia, hepatic abscess formation, carcinoid crisis, and metastatic burden on cross-sectional imaging. Results. In 2005-2009, 72 patients underwent 174 HAEs for carcinoid and islet cell tumors. The median LOS was 4 days (range, 1-8 days). There was no correlation between peak LFTs and tumor burden. Declines in LFTs were not uniform before hospital discharge; 25{\%}, 37{\%}, 30{\%}, 53{\%}, and 67{\%} of patients were discharged before their respective aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase, and total and direct bilirubin levels began to decline, with no readmissions for acute hepatic failure. The median i.v. analgesia dose was 60 mg oral morphine equivalents (range, 3-1,961 mg). Pre-HAE i.v. antibiotics were administered in 99{\%} of cases; post-HAE fever occurred in 37{\%} of patients, with no documented bacteremia. One patient developed a hepatic abscess after HAE. There were two carcinoid crises. The single in-hospital death was associated with air in the portal veins. Conclusions. The duration and intensity of in-hospital care following HAE should be managed on an individual basis. A downward trend in LFTs is not required before discharge. Modest use of i.v. analgesia suggests that many patientscould exclusively receive oralanalgesics. Given the rarity of serious complications, hospital stays could be shortened, thereby reducing costs and nosocomial risks.",
keywords = "Embolization, Liver metastasis, Neuroendocrine, Practice improvement",
author = "Lewis, {Mark A.} and Sylvia Jaramillo and Roberts, {Lewis Rowland} and Fleming, {Chad J.} and Joseph Rubin and Grothey, {Axel F}",
year = "2012",
doi = "10.1634/theoncologist.2011-0372",
language = "English (US)",
volume = "17",
pages = "725--731",
journal = "Oncologist",
issn = "1083-7159",
publisher = "AlphaMed Press",
number = "5",

}

TY - JOUR

T1 - Hepatic artery embolization for neuroendocrine tumors

T2 - Postprocedural management and complications

AU - Lewis, Mark A.

AU - Jaramillo, Sylvia

AU - Roberts, Lewis Rowland

AU - Fleming, Chad J.

AU - Rubin, Joseph

AU - Grothey, Axel F

PY - 2012

Y1 - 2012

N2 - Background. There is scant evidence to guide the management of patients after hepatic artery embolization (HAE). We examined length of stay (LOS), laboratory patterns, medication usage, morbidity, and mortality of patients hospitalized after HAE for metastatic neuroendocrine tumors. Methods. Data were abstracted retrospectively from electronic medical records on LOS, liver function tests (LFTs), i.v. antibiotics, analgesia, peak temperature, bacteremia, hepatic abscess formation, carcinoid crisis, and metastatic burden on cross-sectional imaging. Results. In 2005-2009, 72 patients underwent 174 HAEs for carcinoid and islet cell tumors. The median LOS was 4 days (range, 1-8 days). There was no correlation between peak LFTs and tumor burden. Declines in LFTs were not uniform before hospital discharge; 25%, 37%, 30%, 53%, and 67% of patients were discharged before their respective aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase, and total and direct bilirubin levels began to decline, with no readmissions for acute hepatic failure. The median i.v. analgesia dose was 60 mg oral morphine equivalents (range, 3-1,961 mg). Pre-HAE i.v. antibiotics were administered in 99% of cases; post-HAE fever occurred in 37% of patients, with no documented bacteremia. One patient developed a hepatic abscess after HAE. There were two carcinoid crises. The single in-hospital death was associated with air in the portal veins. Conclusions. The duration and intensity of in-hospital care following HAE should be managed on an individual basis. A downward trend in LFTs is not required before discharge. Modest use of i.v. analgesia suggests that many patientscould exclusively receive oralanalgesics. Given the rarity of serious complications, hospital stays could be shortened, thereby reducing costs and nosocomial risks.

AB - Background. There is scant evidence to guide the management of patients after hepatic artery embolization (HAE). We examined length of stay (LOS), laboratory patterns, medication usage, morbidity, and mortality of patients hospitalized after HAE for metastatic neuroendocrine tumors. Methods. Data were abstracted retrospectively from electronic medical records on LOS, liver function tests (LFTs), i.v. antibiotics, analgesia, peak temperature, bacteremia, hepatic abscess formation, carcinoid crisis, and metastatic burden on cross-sectional imaging. Results. In 2005-2009, 72 patients underwent 174 HAEs for carcinoid and islet cell tumors. The median LOS was 4 days (range, 1-8 days). There was no correlation between peak LFTs and tumor burden. Declines in LFTs were not uniform before hospital discharge; 25%, 37%, 30%, 53%, and 67% of patients were discharged before their respective aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase, and total and direct bilirubin levels began to decline, with no readmissions for acute hepatic failure. The median i.v. analgesia dose was 60 mg oral morphine equivalents (range, 3-1,961 mg). Pre-HAE i.v. antibiotics were administered in 99% of cases; post-HAE fever occurred in 37% of patients, with no documented bacteremia. One patient developed a hepatic abscess after HAE. There were two carcinoid crises. The single in-hospital death was associated with air in the portal veins. Conclusions. The duration and intensity of in-hospital care following HAE should be managed on an individual basis. A downward trend in LFTs is not required before discharge. Modest use of i.v. analgesia suggests that many patientscould exclusively receive oralanalgesics. Given the rarity of serious complications, hospital stays could be shortened, thereby reducing costs and nosocomial risks.

KW - Embolization

KW - Liver metastasis

KW - Neuroendocrine

KW - Practice improvement

UR - http://www.scopus.com/inward/record.url?scp=84861591919&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84861591919&partnerID=8YFLogxK

U2 - 10.1634/theoncologist.2011-0372

DO - 10.1634/theoncologist.2011-0372

M3 - Article

VL - 17

SP - 725

EP - 731

JO - Oncologist

JF - Oncologist

SN - 1083-7159

IS - 5

ER -