Multimodal cytoreduction for carcinoid liver metastases: analysis of a case series with highly advanced disease

Summary BACKGROUND: The objective of our study was to assess the efficacy of multimodal hepatic cytoreduction in symptomatic patients with advanced hepatic metastases from carcinoid disease. METHODS: A retrospective analysis of prospectively collected data was performed. All consecutive patients, who underwent cytoreductive treatment for their metastatic carcinoid liver disease between October 1996 and October 2004, were enrolled. Treatment modalities included resection, radiofrequency with ethanol ablation, chemoembolization, or combined therapy. RESULTS: Fifteen patients, mean age 61 (SD 11) years, underwent cytoreduction. Twelve (80%) patients had extensive bilobar disease and 3 (20%) had solitary lesions. Eleven patients underwent one or more palliative surgical debulking procedures. Two patients had curative resection, and 2 patients had chemoembolization only due to unacceptable anesthesia risk. With a mean follow-up after 29 months (SD 22.1), 6 patients (40%) had stable disease, 8 (53.3%) had progression of disease and 1 (6.6%) had no disease at all. Death grasped 4 patients of which 2 died due to progression of disease. The median symptom relief period was 12 months. Overall survival was 57 months (mean) from the time of hepatic cytoreduction. CONCLUSIONS: Aggressive hepatic cytoreduction in patients with advanced metastatic carcinoid disease can achieve excellent overall survival but needs improvement in long-term symptom control.