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Case report on the role of radiofrequency-assisted spleen-preserving surgery for splenic metastasis in the era of check-point inhibitors.

Abstract An isolated splenic metastasis is a rare phenomenon noted in advanced stage melanoma. We report the role of radiofrequency (RF) -based splenic-preserving splenectomy in a patient with a solitary splenic metastasis from advanced stage melanoma that was managed with checkpoint inhibitors.
PMID
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Authors

Mayor MeshTerms
Keywords
Journal Title medicine
Publication Year Start




PMID- 29245341
OWN - NLM
STAT- MEDLINE
DCOM- 20180105
LR  - 20180105
IS  - 1536-5964 (Electronic)
IS  - 0025-7974 (Linking)
VI  - 96
IP  - 49
DP  - 2017 Dec
TI  - Case report on the role of radiofrequency-assisted spleen-preserving surgery for 
      splenic metastasis in the era of check-point inhibitors.
PG  - e9106
LID - 10.1097/MD.0000000000009106 [doi]
AB  - RATIONALE: An isolated splenic metastasis is a rare phenomenon noted in advanced 
      stage melanoma. We report the role of radiofrequency (RF) -based
      splenic-preserving splenectomy in a patient with a solitary splenic metastasis
      from advanced stage melanoma that was managed with checkpoint inhibitors. PATIENT
      CONCERNS: We report a case of a 60-year-old man who presented with multiple lung 
      metastases and a solitary splenic metastasis with advanced stage melanoma
      following excision of primary from his trunk 2.3 years back. DIAGNOSIS:
      Considering the diagnosis of advanced stage melanoma with multiple lung
      metastases and a solitary splenic metastasis, and its ongoing progressive nature.
      This case was discussed in the tumour board meeting. INTERVENTIONS: A decision
      was made to commence treatment with immunotherapy in the form of PD-1 inhibitor
      (programmed cell death 1 receptor) pembrolizumab. Follow-up restaging computer
      tomography (CT) scan of the abdomen and chest showed a significant reduction in
      the lung and chest wall lesions, but the splenic lesion remained unchanged. Given
      the lack of response to treatment in the splenic metastasis and the significant
      decrease in lung metastases, the multidisciplinary team decided that a partial
      splenectomy combined with continued immunotherapy treatment would be appropriate 
      as the success of immunotherapy was imminent within the splenic preservation.
      OUTCOMES: The postoperative recovery was smooth and the patient was discharged
      from hospital on the sixth postoperative day with normal platelets and white
      blood cells. The histopathological analysis of the resected specimen showed a
      metastatic melanoma with negative margins.At 10-month follow-up after the splenic
      resection the patient had not experienced further tumour recurrences. LESSONS:
      Spleen-preserving resection for an isolated, solitary splenic metastasis of
      melanoma is a feasible approach as it not only preserves the ongoing efficacy of 
      checkpoint inhibitors by preserving the physiological T cell milieu, but the
      immunomodulation properties of RF can produce potentially additional therapeutic 
      benefit.
FAU - Mudan, Satvinder
AU  - Mudan S
AD  - aDepartment of Surgery, The Royal Marsden NHS Trust, SuttonbDepartment of Surgery
      & Cancer, Imperial College LondoncDepartment of Oncology, St George's Hospital,
      London, UK.
FAU - Kumar, Jayant
AU  - Kumar J
FAU - Mafalda, Neves C
AU  - Mafalda NC
FAU - Kusano, Tomokazu
AU  - Kusano T
FAU - Reccia, Isabella
AU  - Reccia I
FAU - Zanallato, Artur
AU  - Zanallato A
FAU - Dalgleish, Angus
AU  - Dalgleish A
FAU - Habib, Nagy
AU  - Habib N
LA  - eng
PT  - Case Reports
PT  - Journal Article
PL  - United States
TA  - Medicine (Baltimore)
JT  - Medicine
JID - 2985248R
RN  - 0 (Antibodies, Monoclonal, Humanized)
RN  - 0 (Antineoplastic Agents, Immunological)
RN  - DPT0O3T46P (pembrolizumab)
SB  - AIM
SB  - IM
MH  - Ablation Techniques/*methods
MH  - Antibodies, Monoclonal, Humanized/therapeutic use
MH  - Antineoplastic Agents, Immunological/therapeutic use
MH  - Humans
MH  - Lung Neoplasms/drug therapy/secondary
MH  - Male
MH  - Melanoma/drug therapy/*pathology
MH  - Middle Aged
MH  - Splenectomy/*methods
MH  - Splenic Neoplasms/drug therapy/*secondary/*surgery
PMC - PMC5728956
EDAT- 2017/12/17 06:00
MHDA- 2018/01/06 06:00
CRDT- 2017/12/17 06:00
PHST- 2017/12/17 06:00 [entrez]
PHST- 2017/12/17 06:00 [pubmed]
PHST- 2018/01/06 06:00 [medline]
AID - 10.1097/MD.0000000000009106 [doi]
AID - 00005792-201712080-00130 [pii]
PST - ppublish
SO  - Medicine (Baltimore). 2017 Dec;96(49):e9106. doi: 10.1097/MD.0000000000009106.