Simultaneous Spleno-Pancreatectomy and Mini-ALPPS Approach for the Treatment of Metastatic Functional Gastrinoma

Cecilia Jorge

Italian Hospital of Buenos Aires, Argentina

^*Correspondance to: Cecilia Jorge 

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Abstract:

Background: Gastrinomas are rare functional neuroendocrine tumors primarily located in the duodenum or pancreas, causing Zollinger-Ellison syndrome. At presentation, up to 25% of gastrinomas are metastasized, predominantly to the liver. The presence of liver metastases has a negative impact on the prognosis. Liver resection for neuroendocrine metastases is associated to long-term survival advantages and disease control. Nevertheless, the benefits of aggressive liver resection should be weighed against the potential risk of post-hepatectomy liver failure. Summary: This report presents the case of a 41-year-old female patient who presented severe diarrhea due to a pancreatic functional gastrinoma with synchronic hepatic metastases. Preoperative assessment of future liver remnant function through a newly developed dynamic measure calculated using hepatobiliary scintigraphy -HIBA index- is described. The present case report also underlines a two-stage surgical management consisting of Mini-ALPPS procedure, distal pancreatectomy and splenectomy which allowed primary and secondary lesions to be fully resected. Conclusion: Liver metastatic pancreatic neuroendocrine tumors can be approached through an aggressive R0 resection with curative intent as long as a meticulous appraisal of future liver remnant function is conducted to ensure the patient's postoperative safe and uneventful recovery.

Keywords:

Gastrinoma; Pancreas; Liver metastases; Hepatectomy; Future liver remnant

Cite the Article:

Jorge C. Simultaneous Spleno- Pancreatectomy and Mini-ALPPS Approach for the Treatment of Metastatic Functional Gastrinoma. Clin Case Rep Int. 2022; 6: 1311.