TY - JOUR
T1 - Hepatic artery embolization for neuroendocrine tumors
T2 - Postprocedural management and complications
AU - Lewis, Mark A.
AU - Jaramillo, Sylvia
AU - Roberts, Lewis
AU - Fleming, Chad J.
AU - Rubin, Joseph
AU - Grothey, Axel
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
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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
C2 - 22511263
AN - SCOPUS:84861591919
SN - 1083-7159
VL - 17
SP - 725
EP - 731
JO - Oncologist
JF - Oncologist
IS - 5
ER -