Surgical intervention for portal hypertension caused by oxaliplatin-based chemotherapy: a case report and a review of li
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CASE REPORT
Surgical intervention for portal hypertension caused by oxaliplatin‑based chemotherapy: a case report and a review of literature regarding radiological and/or surgical interventions for oxaliplatin‑associated portal hypertension Daisuke Morioka1 · Yusuke Izumisawa1 · Kazuya Yamaguchi1 · Kei Sato2 · Satoshi Komiyama2 · Kazuya Nakagawa2 · Manabu Kakizoe2 · Takashi Murakami3 · Yoshiki Sato1 Received: 25 May 2020 / Accepted: 10 June 2020 © The Author(s) 2020
Abstract A 63-year-old man showed massive ascites, massive pleural effusion, severe lower-extremity edema, and repeated esophageal variceal bleeding. Two-year previously, he received 13-courses of oxaliplatin-based chemotherapy (OBC) followed by associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) for multiple colorectal cancer liver metastases but developed a solitary remaining liver metastasis and multiple lung metastases 2 months after the ALPPS, for which multiple regimens of chemotherapy were conducted. The symptoms were considered attributable to the OBC-associated portal-hypertension. Water-retention symptoms were mitigated by the use of tolvaptan but the variceal bleeding necessitated frequent endoscopic treatments and disallowed restarting antineoplastic treatment. Transjugular intrahepatic portosystemic shunt (TIPS) was considered undesirable because TIPS in this patient might have prohibited future repeat hepatectomy. Thus, the patient underwent splenectomy and surgical portosystemic shunting. Since then, the portal-hypertension symptoms were completely resolved. Thereafter, chemotherapy was able to be recommenced. Moreover, repeat hepatectomy was performed. A literature review demonstrated that radiological and/or surgical interventions for the OBC-associated portalhypertension have been reported in 31 cases to date. However, this report is the first to show a case of successful treatment of the OBC-associated portal-hypertension with splenectomy and surgical portosystemic shunting, which allowed subsequent chemotherapy followed by repeat hepatectomy. Keywords Oxaliplatin-based chemotherapy · Portal hypertension · Portosystemic shunt
* Daisuke Morioka [email protected]
Takashi Murakami [email protected]
Yusuke Izumisawa [email protected]
Yoshiki Sato [email protected]
Kazuya Yamaguchi [email protected]
1
Kei Sato keisat0@yokohama‑cu.ac.jp
Department of Surgery, Yokohama Ekisaikai Hospital, 1‑2 Yamada‑cho, Naka‑ku, Yokohama 231‑0036, Japan
2
Satoshi Komiyama skomiyam@yokohama‑cu.ac.jp
Gastroenterology Unit, Gastroenterological Center, Yokohama City University, Yokohama, Japan
3
Department of Surgery, Teikyo Chiba Medical Center, Chiba, Japan
Kazuya Nakagawa [email protected] Manabu Kakizoe [email protected]
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Abbreviations OBC Oxaliplatin-based chemotherapy SOS Sinusoidal obstruction syndrome PSE Partial splenic embolization TIPS Transjugular intrahepatic portosystemic shunt BSC Best supportive
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