Liver metastases

Foster, James H.; Lundy, Joel

doi:10.1016/s0011-3840(81)80009-3

Cited by 118 publications

(54 citation statements)

References 57 publications

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“…So-called debulking, or cytoreductive, liver surgery can be performed according to similar principles in cases with slow tumour growth and severe hormonal symptoms. Palliative liver resections are generally performed in patients in whom more than 90% of the tumour volume can be safely excised [9, 10]. The role of debulking surgery for enhanced survival has not yet been proven in randomized studies.…”

Section: Interventional Treatment Modalitiesmentioning

confidence: 99%

Interventional Treatment of the Carcinoid Syndrome

Ahlman¹,

Nilsson

Olausson³

2004

Neuroendocrinology

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Liver metastases imply a major problem in patients with carcinoid tumours and hormone overproduction. Patients with distant metastases can undergo resection for potential cure or for symptom palliation. In patients with bilobar liver metastases other interventions are at hand, e.g. local ablation or hepatic arterial embolization. In selected cases liver transplantation can be a treatment alternative. Prior to all interventions patients with midgut carcinoids are protected with somatostatin analogues to reduce hormone secretion. Patients with foregut carcinoids may present special problems with life-threatening release of histamine during interventions.

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Section: Interventional Treatment Modalitiesmentioning

confidence: 99%

Interventional Treatment of the Carcinoid Syndrome

Ahlman¹,

Nilsson

Olausson³

2004

Neuroendocrinology

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“…All patients were surgically explored and underwent radical surgery or surgical debulking, if more than 90% of the intrahepatic metastases could be removed safely (cf. Foster and Lundy, 1981). Tumour staging was done according to the 1997 TNM classification of pancreatic carcinoma (Table 1) Eleven out of the 25 EPT patients were resected for cure.…”

Section: Patients and Treatmentmentioning

confidence: 99%

Comparison of survival between malignant neuroendocrine tumours of midgut and pancreatic origin

et al. 1999

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Neuroendocrine tumours of the gastrointestinal tract are rare diseases and with the presence of metastases, patients may suffer from disabling symptoms of hormone overproduction. Potentially curative surgery can be performed in patients with localized disease, and sometimes in patients with liver metastases. However, long-term follow-up of the latter patients mostly shows late tumour recurrences (Norton, 1994). Debulking (cytoreductive) surgery can be considered when most of the tumour burden can be excised safely to minimize hormonal symptoms and to facilitate medical therapy (McEntee et al, 1990;Carty et al, 1992;Que et al, 1995). An important question is whether the aggressive treatment of metastatic disease prolongs survival. No randomized studies are available today. Such studies are complicated by the lack of strict surgical treatment protocols running over long periods, the relatively low number of patients and the absence of a TNM (tumour, node, metastases) classification of these tumour types. Many clinical studies, in which debulking surgery and resection rates are discussed, are composed of patients with carcinoids and those with endocrine pancreatic tumours (EPT). However, these two disease entities may include tumours with markedly different biology.In our consecutive series of patients with advanced midgut carcinoids (all with locoregional and hepatic metastases) the estimated overall 5-year survival was 69% after active interventional treatment. The 5-year survival of carcinoid patients with bilobar liver metastases was 63% (cf. Wängberg et al, 1996). These figures are superior to the ones obtained after more conservative treatment. In a consecutive series of 42 patients with metastatic EPT from National Institutes of Health, the 5-year survival of those 17 patients resected for cure was 79% versus 28% in the non-resected group (Carty et al, 1992). Similar results were recently reported from the Mayo Clinic in 74 patients with hepatic metastases from either EPT or carcinoid tumours. The 4-year survival was 85% for one-third of the patients selected for resection versus 65% for the two-thirds non-resected (Que et al, 1995). In a recent French series of 34 patients with neuroendocrine tumours (carcinoids and EPT) and hepatic metastases, the liver resection rate was as high as 50%. Twelve of these 17 patients were operated upon with curative intent (Dousset et al, 1996).The aim of this retrospective study was to compare survival in our consecutive series of patients with malignant EPT with that of patients with advanced midgut carcinoids when subjected to similar treatment principles. Furthermore, EPT were staged according to the TNM classification of pancreatic carcinoma. By doing so, stage IV tumours should be compared with advanced carcinoid tumours with liver metastases.  Patients and treatmentThe 64 consecutive patients with advanced midgut carcinoids were treated during 1987-1997 (cf. Wängberg et al, 1996. All patients underwent primary surgery, removal of the primary tumo...

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“…Palliative liver surgery can be considered for some patients with slow tumour growth and severe hormonal symptoms. Palliative liver resections are generally performed in patients in whom more than 90% of the tumour volume can be safely excised [14, 15]. In a series of patients with NE tumours 10 years ago, the liver resection rate with curative intent was about 10% [16, 17].…”

Section: Resultsmentioning

confidence: 99%

Interventional Treatment of Gastrointestinal Neuroendocrine Tumours

et al. 2000

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Neuroendocrine (NE) tumours of the gastrointestinal tract (carcinoids and endocrine pancreatic tumours) are rare diseases. In the presence of liver metastases these patients may suffer from disabling symptoms due to hormone overproduction. Patients with localized disease can be resected for cure and also patients with liver metastases can undergo potentially curative tumour resection. However, long-term follow-up of the latter cases indicates frequent recurrence of tumour. Using close biochemical monitoring of tumour markers combined with newer techniques for tumour visualization, these recurrences can often be diagnosed at an early stage so that repeat surgical procedures can be performed. During the last years very active surgery has been recommended for NE tumours, many of which have a relatively slow growth. Even in patients not amenable to curative liver surgery, debulking can be considered if the main tumour burden can be safely excised. The primary aim of this type of treatment is palliation of hormonal symptoms. An important question is whether the aggressive treatment actually prolongs survival. No prospective studies have been performed. Such studies are hampered by the lack of strict surgical programs running over long periods and the relative rarity of NE tumours. Liver transplantation may be another treatment modality in selected cases.

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Liver metastases

Cited by 118 publications

References 57 publications

Interventional Treatment of the Carcinoid Syndrome

Interventional Treatment of the Carcinoid Syndrome

Comparison of survival between malignant neuroendocrine tumours of midgut and pancreatic origin

Interventional Treatment of Gastrointestinal Neuroendocrine Tumours

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