Post-procedure Hyponatremia in Patients Undergoing Liver Embolotherapy for Neuroendocrine Tumor Metastases

Monday, March 6, 2023

3:45 PM – 3:54 PM

Location: Phoenix Convention Center, 225AB

Presenting Author(s)

Nikki Okwelogu, BA (she/her/hers)

MS4
UCSF

Disclosure(s): No financial relationships to disclose

Author/Co-author(s)

PV

Parmede Vakil, MD, PhD

Resident Physician
UCSF
EB

Emily Bergsland, MD

Professor of Clinical Medicine
UCSF
LR

Leticia Rolon, MD

Associate Professor
UCSF
NF

Nicholas Fidelman, MD

Professor
University Of California San Francisco

Disclosure(s):

Nikki Okwelogu, BA: No financial relationships to disclose

Nicholas Fidelman, MD: Boston Scientific: Research Grant or Support (); Merck: Research Grant or Support (); Sirtex Medical: Research Grant or Support ()

Purpose: Describe the incidence of and consider predictive factors for developing hyponatremia after hepatic transcatheter arterial chemoembolization (TACE) and transcatheter arterial embolization (TAE) for well-differentiated neuroendocrine tumor liver metastases (NETLM).

Materials and Methods: Data for all outpatient TACE and TAE procedures performed at our institution for patients with NETLM between January 2012 and July 2022 were retrospectively collected. TAE was performed with trisacryl gelatin microspheres ranging from 40-700 microns. TACE procedures were performed with doxorubicin and mitomycin C mixed with ethiodized oil and particulate embolics. Concurrent antihypertensive, diuretic, antiemetic, opiate medication, and intravenous fluid use within 24 hours of the procedures were noted. Univariate analysis of predictor variables was performed using X2 and two sample t-tests. P value < 0.05 was considered significant.

Results: A total of 102 patients (54% men; median age 64 years, range 28 to 79) who underwent 185 procedures were included. The small bowel was the most common primary tumor site (n=54) followed by the pancreas (n=24). Tumors were WHO grade 1, 2, and 3 for 34, 54, and 10 patients, respectively. Of 185 procedures, 69 (37%) were complicated by post-procedure hyponatremia (54 Grade 1, 11 Grade 2, 3 Grade 3, and 1 Grade 4). The median time to sodium nadir was 1 day. Eleven patients with Grade 2-4 hyponatremia (Na< 130) received a medical work-up, and eight of them were diagnosed with syndrome of inappropriate antidiuretic hormone secretion (SIADH). All patients with hyponatremia were asymptomatic and none required admission to intensive care due to hyponatremia. The average length of hospital stay for patients with post-procedure eunatremia was 43 hours, compared to 43 hours for grade 1 hyponatremia (p= 0.98), and 68 hours for grade 2-4 hyponatremia (p=0.03). Grade 2-4 hyponatremia was associated with female gender (p=.00015) and the need for three or more antiemetic drugs (p=.0027). 

Conclusion: Hyponatremia was a common complication of embolotherapy for patients with NETLM. Mild hyponatremia did not significantly prolong hospital stays. However, hyponatremia warranting medical intervention (Na< 130) resulted in a significant hospital stay length prolongation, was commonly due to SIADH, and was associated with severe post-procedural nausea requiring the use of at least three different classes of antiemetics.