Rapid-Onset Acute Respiratory Distress Syndrome (ARDS) in a Patient Undergoing Metastatic Liver Resection: A Case Report and Review of the Literature

Abstract

Metastatic liver resection following cytoreductive chemotherapy is an accepted treatment for oligometastatic tumor diseases. Although pulmonary complications are frequently reported in patients undergoing liver surgery including liver transplantation, life-threatening acute respiratory failures in the absence of aspiration, embolism, transfusion-related acute lung injury (TRALI), pulmonary infection, or an obvious source of systemic sepsis are rare. We performed an extensive clinical review of a patient undergoing metastatic liver resection who had a clinical course compatible to an acute respiratory distress syndrome (ARDS) without an obvious cause except for the surgical procedure and multiple preoperative chemotherapies. We hypothesize that either the surgical procedure mediated by cytokines and tumor necrosis factor or possible toxic effects of oxygen applied during general anesthesia were associated with life-threatening respiratory failure in the patient. Discrete and subclinical inflammated alveoli (probably due to multiple preoperative chemotherapies with substances at potential risk for interstitial pneumonitis as well as chest radiation) might therefore be considered as risk factors.

Pulmonary Radiofrequency Ablation Complicated by Acute Respiratory Distress Syndrome

“…They proposed multiple possible mechanisms that could have led to respiratory failure: endotracheal tube displacement, aspiration, pulmonary embolism, cardiac ischemia with resultant pulmonary edema, transfusion associated lung injury (1:2000-5000 patients receiving plasma may have acute lung injury related to donor-specific antibodies, however, our patient did not receive a transfusion prior to ARDS development), sepsis, pneumonia, respiratory burst, and tumor-associated cytokine storm. 13 These last two possibilities are worth further discussion in our case.…”

Small-For-Size Liver Transplantation Increases Pulmonary Injury in Rats: Prevention by NIM811

“…A previous report showed that liver splitting procedures cause leukocyte recruitment in the lung tissue of donor [18]. Rapid onset of acute respiratory distress syndrome is also observed after major hepatectomy [19]. Hemodynamic alterations occurring after small-forsize LT could also lead to pulmonary complications [20,21].…”

Acute Respiratory Distress Syndrome After Pancreaticoduodenectomy

“…Haga et al reported that the prevalence of ARDS was 1.3% after gastrointestinal surgery, including esophagectomy, pancreaticoduodenectomy (PD), hepatectomy, gastrectomy, colorectal resection, and laparoscopic cholecystectomy; the subsequent mortality rate, however, was not mentioned (12). Brenner et al reported a case of ARDS after a metastatic liver resection (13). However, no report focusing on ARDS after pancreatectomy has been published to date.…”