• Online Features  This Article  • Full text  • PDF  • Reply to article  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citing articles on Web of Science (4)  • Contact me when this article is cited  Related Content  • Related article  • Similar articles in this journal  Topic Collections  • Surgery  • Surgical Interventions  • Surgical Oncology  • Transplantation  • Liver Transplantation  • Hepatobiliary Surgery  • Gastroenterology  • Liver/ Biliary Tract/ Pancreatic Diseases  • Alert me on articles by topic  Social Bookmarking   What's this?

A Single-Institution Experience With 25 Cases

Jon Cardinal, MD; Michael E. de Vera, MD; James W. Marsh, MD; Jennifer L. Steel, PhD; David A. Geller, MD; Paulo Fontes, MD; Michael Nalesnik, MD; T. Clark Gamblin, MD

Arch Surg. 2009;144(11):1035-1039.

Objective  To examine treatment of hepatic epithelioid hemangioendothelioma (EHE), a rare vascular tumor with a variable course. Treatment modalities at our institution include liver resection, transplantation, and catheter-based therapies.

Design, Patients, and Main Outcome Measures  Retrospective review of 25 patients treated for hepatic EHE (1976-2007). We examined treatment modality, overall survival, complications, and clinicopathologic characteristics.

Results  Of the 25 patients treated for hepatic EHE, 17 underwent liver transplantation (LT); 4, transcatheter arterial chemoembolization (TACE); 2, resection; and 2, TACE followed by LT. Twelve patients (48%) were male. The median age at diagnosis was 38 years (range, 9 months to 72 years). Mean overall survival was 167 (95% confidence interval [CI], 123-212) months, with 172 (124-220) months in the LT group and 83 (54-112) months in the TACE group. The 2 patients in the resection group remain alive after 19 and 71 months. The 2 patients treated with TACE followed by LT died after 13 and 113 months. Extrahepatic disease was identified as a predictor of outcome. Patients with extrahepatic disease treated with TACE fared better than those treated with surgical approaches (mean survival, 83.0 [95% CI, 54.2-111.8] vs 38.8 [23.7-53.8] months; P = .12).

Conclusions  Hepatic EHE is a rare tumor that can be treated with surgical or nonsurgical approaches. In our experience, LT is used for patients with advanced local disease, whereas TACE is the primary modality when extrahepatic disease or comorbid conditions prohibiting LT are present. To our knowledge, this is the largest single-institution experience describing the various therapeutic modalities in the treatment of hepatic EHE.

Author Affiliations: Thomas E. Starzl Transplantation Institute (Drs Cardinal, de Vera, Marsh, Steel, Geller, Fontes, Nalesnik, and Gamblin) and Departments of Surgery (Drs Cardinal, de Vera, Marsh, Geller, Fontes, and Gamblin), Psychiatry (Dr Steel), and Pathology (Dr Nalesnik), University of Pittsburgh, Pittsburgh, Pennsylvania.

CiteULike    Connotea    Delicious    Digg    Facebook    Reddit    Technorati    Twitter     What's this?

RELATED ARTICLE

Getting a Handlle on Managing Rare Tumors: Comment on "Treatment of Hepatic Epithelioid Hemangioendothelioma"
James C. Hebert
Arch Surg. 2009;144(11):1039.
EXTRACT | FULL TEXT