Sinusoidal Obstruction Syndrome after Neoadjuvant Folfirinox for Locally Advanced Pancreatic Cancer

Garrick Trapp, Michael D. Kluger, Stephen M. Schreibman and Beth A. Schrope

Department of Surgery, Pancreas Center, Columbia University Medical Center, USA

^*Correspondance to: Beth A. Schrope 

 PDF  Full Text DOI: 10.25107/2474-1647.1199

Abstract

A 69-year-old woman diagnosed with pancreatic adenocarcinoma underwent 11 cycles of FOLFIRINOX. Despite some minor complications, she mostly tolerated the neoadjuvant chemotherapy therapy. After eleven cycles of FOLFIRINOX, the mass had decreased, and it was determined she was a candidate for resection: a pancreaticoduodenectomy procedure with superior mesenteric and portal vein reconstruction. Upon the exploratory laparoscopy, she had the appearance of a “blue liver,” consistent with sinusoidal congestion or obstruction but otherwise the liver was normal size without any metastasis. A day after her surgery, the patient became acidotic, anuric, and pressor dependent and succumbed to multisystem organ failure that evening. FOLFIRINOX contains oxaliplatin and there is a strong, documented correlation between oxaliplatin and an increased risk of sinusoidal obstruction syndrome in colorectal cancer patients. As neoadjuvant chemotherapy becomes the standard for locally advanced pancreatic cancer patients, more research is needed to understand the correlation between oxaliplatin and pancreatic cancer patients to reduce potential perioperative complications with particular attention paid to patients receiving higher cycle counts of FOLFIRINOX or other oxaliplatin based treatments.

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Cite the article

Trapp G, Kluger MD, Schreibman SM, Schrope BA. Sinusoidal Obstruction Syndrome after Neoadjuvant Folfirinox for Locally Advanced Pancreatic Cancer. Clin Surg. 2016; 1: 1199.