Surgical Treatment of a Primary Tumour and Liver Metastases in a Patient With Intracranial Haemangiopericytoma

Case Study

Abstract

Cancers exhibit a spectrum of behaviours ranging from aggressive malignancy to those which progress in an almost benign fashion. An appreciation of this aspect of tumour biology is crucial when planning patient management as non-curative debulking procedures for slower growing tumours often still confer a survival benefit. The present report is a case in point.

Haemangiopericytoma is a rare cancer whilst clear indications for an ALPPS procedure are still evolving. Inherent to the patient groups in whom ALPPS is considered is the presence of advanced underlying disease. Many of these patients would previously not be considered for liver resection or have progressed beyond resectability by the time sufficient hypertrophy of their future liver remnant had been achieved using conventional two-stage hepatectomy techniques.

ALPPS offers another treatment option for these patients, although at a cost. Early experience reported unacceptably high morbidity and mortality rates following ALPPs resection and suggested that tumour type and patient fitness were key factors in determining outcome. The patient must be fit enough to withstand two major operations 1-2 weeks apart. The slow growing nature of the tumour in the present case combined with the fit, motivated patient meant that, despite developing post-operative liver insufficiency, Mr X still recovered well.

As is so often the case in surgery, patient selection is key