A Rare Complication of Transcatheter Arterial Injection for Multiple Liver Metastases of Rectal Neuroendocrine Tumor - A Case Report

A 50-year-old man was diagnosed with multiple bilobar liver metastases of rectal neuroendocrine tumor(NET). Although he received octreotide for 6 months and everolimus for 10 months, the liver metastases gradually increased in size. Therefore, we decided to perform transcatheter arterial infusion(TAI)with miriplatin. The serum total bilirubin level increased to 13.1 mg/dL 9 days after treatment, and it took 2 months to return to the normal range. CT scan demonstrated that most of the liver tumors had remarkably shrunk 4 months after treatment, and the patient has no sign of tumor regrowth even 12 months after treatment. Retrospective analysis of our cases(98 procedures of[transcatheter arterial chemoembolization: TACE]or TAI for liver tumors performed at the Department of General Surgery, Chiba University from 2012 to 2015)revealed that serum biliary enzymes levels 7 days after TACE were significantly higher in patients with metastatic liver tumors than those in patients with hepatocellular carcinoma. These data suggest that the TACE procedure might lead to severe damage of the biliary system in patients with metastatic liver tumors. Although the morbidity rate of TAI is very low, the procedure should be performed with caution, especially for patients with liver metastases.