Tsunematsu Masashi, Haruki Koichiro, Saito Ryota, Watanabe Michiaki, Masubuchi Masataka, Yanaga Katsuhiko
Department of Surgery, Atsugi City Hospital, 1-16-36 Mizuhiki, Atsugi, Kanagawa Prefecture, 243-8588, Japan.
Department of Surgery, The Jikei University School of Medicine, 3-19-18 Nishi-shinbashi, Minato-ku, Tokyo, 105-8471, Japan.
Clin J Gastroenterol. 2019 Dec;12(6):552-555. doi: 10.1007/s12328-019-00978-8. Epub 2019 Apr 6.
Everolimus is an mTOR (the mammalian target of rapamycin) inhibitor, which is used for the treatment of advanced renal cell carcinoma. Life-threatening hemorrhages are extremely rare adverse effect of everolimus. We herein report a successfully treated case of severe everolimus-related gastrointestinal hemorrhage by emergency surgical resection for patient with advanced renal cell carcinoma. A 72-year-old male was diagnosed with renal cell carcinoma, for which everolimus was administered after unsuccessful treatment with sunitinib and sorafenib. The patient suddenly developed hematemesis 4 weeks after administration. Upper gastrointestinal endoscopy showed gastric antral vascular ectasia. Once the hemorrhage was successfully cauterized by argon plasma coagulation, everolimus was discontinued. However, the patient after re-administration of everolimus developed hematemesis again and exhibited hemorrhage shock. Since therapeutic endoscopy could not achieve hemostasis, the patient underwent emergency distal gastrectomy with Billroth I reconstruction. The patient's vital signs and hemoglobin level stabilized after the surgery. Thereafter, the patient made a satisfactory recovery, and was discharged on postoperative day 10.
依维莫司是一种雷帕霉素靶蛋白（mTOR，哺乳动物雷帕霉素靶点）抑制剂，用于治疗晚期肾细胞癌。危及生命的出血是依维莫司极其罕见的不良反应。我们在此报告一例晚期肾细胞癌患者因依维莫司相关严重胃肠道出血经急诊手术切除成功治愈的病例。一名72岁男性被诊断为肾细胞癌，在舒尼替尼和索拉非尼治疗失败后给予依维莫司治疗。给药4周后患者突然出现呕血。上消化道内镜检查显示胃窦血管扩张。经氩离子凝固术成功止血后，停用依维莫司。然而，患者再次服用依维莫司后再次出现呕血并表现为出血性休克。由于治疗性内镜检查无法止血，患者接受了毕罗Ⅰ式重建的急诊远端胃切除术。术后患者生命体征和血红蛋白水平稳定。此后，患者恢复良好，术后第10天出院。
