Skip to main content
SpringerLink
Log in

Improved Outcome With Cytoreduction Versus Embolization for Symptomatic Hepatic Metastases of Carcinoid and Neuroendocrine Tumors

  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

An Erratum to this article was published on 24 July 2006

Abstract

Background

Few data exist regarding outcomes after resection versus embolic treatment of symptomatic metastatic carcinoid and neuroendocrine tumors. The purpose of this study was to determine whether cytoreduction provides any benefit over embolic management of diffuse neuroendocrine tumors.

Methods

A prospective database of 734 patients treated at our institution was retrospectively queried for symptomatic metastatic tumors treated with embolization or cytoreduction. Patients were compared with regard to pretreatment performance status, relief of symptoms, and survival.

Results

A total of 120 patients were identified: 59 undergoing embolization and 61 undergoing cytoreduction. Twenty-three patients had palliative cytoreduction (gross residual disease). Pretreatment performance status (Eastern Cooperative Oncology Group) was similar for both groups: .7 ± .70 (embolization) versus .8 ± .72 (cytoreduction; P = .27). Complete symptomatic relief was observed in 59% and partial relief in 32% of patients who underwent embolization, with a mean symptom-free interval of 22 ± 13.6 months. A total of 69% of patients who underwent cytoreduction had complete symptomatic relief, and 23% had partial relief (P = .08 vs. embolization). The mean duration of relief was 35 ± 22.0 months (P < .001 vs. embolization). The mean survival for the patients who underwent embolization was 24 ± 15.8 months versus 43 ± 26.1 months for those who underwent cytoreduction (P < .001). Survival in patients who underwent palliative cytoreduction was 32 ± 18.9 months (P < .001 vs. embolization), whereas it was 50 ± 27.6 months in patients who underwent curative resection (P < .001 vs. embolization; P < .001 vs. palliative).

Conclusions

Cytoreduction for metastatic neuroendocrine tumors resulted in improved symptomatic relief and survival when compared with embolic therapy in this nonrandomized study. Cytoreduction should be pursued whenever possible even if complete resection may not be achievable.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Modlin I, Sandor A. An analysis of 8305 cases of carcinoid tumors. Cancer 1997;79:813–29

    Article  PubMed  CAS  Google Scholar 

  2. Newton J, Swerdlow A, dos Santos Silva I, et al. The epidemiology of carcinoid tumours in England and Scotland. Br J Cancer 1994;70:939–42

    PubMed  CAS  Google Scholar 

  3. Moertel C. Karnofsky memorial lecture. An odyssey in the land of small tumors. J Clin Oncol 1987;5:1502–22

    PubMed  CAS  Google Scholar 

  4. Berge T, Linell F. Carcinoid tumours. Frequency in a defined population during a 12-year period. Acta Pathol Microbiol Scand [A] 1976;84:322–30

    CAS  Google Scholar 

  5. Chamberlain R, Canes D, Brown K, et al. Hepatic neuroendocrine metastases: does intervention alter outcomes? J Am Coll Surg 2000;190:432–45

    Article  PubMed  CAS  Google Scholar 

  6. Que F, Nagorney DM, Batts KP, et al. Hepatic resection for metastatic neuroendocrine carcinomas. Am J Surg 1995;169:36–42; discussion 42–3

    Article  PubMed  CAS  Google Scholar 

  7. Crocetti E. Gastrointestinal carcinoid tumours. A population-based study. Ital J Gastroenterol Hepatol 1997;29:135–7

    PubMed  CAS  Google Scholar 

  8. Phan G, Yeo GQ, Hruban RH, et al. Surgical experience with pancreatic and peripancreatic neuroendocrine tumors: review of 125 patients. J Gastrointest Surg 1998;2:472–82

    Article  PubMed  CAS  Google Scholar 

  9. Saltz L, Trochanowski B, Buckely M, et al. Octreotide as an antineoplastic agent in the treatment of functional and nonfunctional neuroendocrine tumors. Cancer 1993;72:244–8

    Article  PubMed  CAS  Google Scholar 

  10. Ruszniewski P, Malka D. Hepatic arterial chemoembolization in the management of advanced digestive endocrine tumors. Digestion 2000;62(Suppl 1):79–83

    Article  PubMed  Google Scholar 

  11. Fraker D, Soulen M. Regional therapy of hepatic metastases. Hematol Oncol Clin North Am 2002;16:947–67

    Article  PubMed  Google Scholar 

  12. Sutcliffe R, Maguire D, Ramage J, et al. Management of neuroendocrine liver metastases. Am J Surg 2004;187:39–46

    Article  PubMed  Google Scholar 

  13. Stephen J, Grahame-Smith DG. Treatment of the carcinoid syndrome by local removal of hepatic metastases. Proc R Soc Med 1972;65:444–5

    PubMed  CAS  Google Scholar 

  14. Strodel W, Talpos G, Eckhauser F, et al. Surgical therapy for small-bowel carcinoid tumors. Arch Surg 1983;118:391–7

    PubMed  CAS  Google Scholar 

  15. Norton J, Sugarbaker PH, Doppman JL, et al. Aggressive resection of metastatic disease in selected patients with malignant gastrinoma. Ann Surg 1986;203:352–9

    PubMed  CAS  Google Scholar 

  16. McEntee G, Nagorney DM, Kvols LK, et al. Cytoreductive hepatic surgery for neuroendocrine tumors. Surgery 1990;108:1091–6

    PubMed  CAS  Google Scholar 

  17. Makridis C, Oberg K, Juhlin C, et al. Surgical treatment of mid-gut carcinoid tumors. World J Surg 1990;14:377–83; discussion 384–5

    Article  PubMed  CAS  Google Scholar 

  18. Soreide O, Berstad T, Bakka A, et al. Surgical treatment as a principle in patients with advanced abdominal carcinoid tumors. Surgery 1992;111:48–54

    PubMed  CAS  Google Scholar 

  19. Grama D, Eriksson B, Martensson H, et al. Clinical characteristics, treatment and survival in patients with pancreatic tumors causing hormonal syndromes. World J Surg 1992;16:632–9

    Article  PubMed  CAS  Google Scholar 

  20. Chen H, Hardacre JM, Uzar A, et al. Isolated liver metastases from neuroendocrine tumors: does resection prolong survival? J Am Coll Surg 1998;187:88–92; discussion 92–3

    Article  PubMed  CAS  Google Scholar 

  21. Thompson GB, Tompkins RK, Longmire WP, et al. Islet cell carcinomas of the pancreas: a twenty-year experience. Surgery 1988;104:1011–7

    PubMed  CAS  Google Scholar 

  22. Ahlman H, Wangberg B, Jansson S, et al. Management of disseminated midgut carcinoid tumours. Digestion 1991;49:78–96

    Article  PubMed  CAS  Google Scholar 

  23. Goto H, Yamaji Y, Konno T, et al. A glucagon-secreting alpha-cell carcinoma of the pancreas. World J Surg 1982;6:107–9

    Article  PubMed  CAS  Google Scholar 

  24. Nagorney DM, Blooms SR, Polak JM, et al. Resolution of recurrent Verner-Morrison syndrome by resection of metastatic vipoma. Surgery 1983;93:348–53

    PubMed  CAS  Google Scholar 

  25. Travis WD, Linnoila RI, Tsokos MG, et al. Neuroendocrine tumors of the lung with proposed criteria for large-cell neuroendocrine carcinoma. An ultrastructural, immunohistochemical, and flow cytometric study of 35 cases. Am J Surg Pathol 1991;15:529–53

    Article  PubMed  CAS  Google Scholar 

  26. Sarmiento JM, Heywood G, Rubin J, et al. Surgical treatment of neuroendocrine metastases to the liver: a plea for resection to increase survival. J Am Coll Surg 2003;197:29–37

    Article  PubMed  Google Scholar 

  27. Foster JH. Survival after liver resection for cancer. Cancer 1970;26:493-502

    Article  PubMed  CAS  Google Scholar 

  28. Iwatsuki S, Shaw BW, Starzl TE. Experience with 150 liver resections. Ann Surg 1983;197:247–53

    PubMed  CAS  Google Scholar 

  29. Thompson HH, Tompkins RK, Longmire WP. Major hepatic resection. A 25-year experience. Ann Surg 1983;197:375–88

    PubMed  CAS  Google Scholar 

  30. Wolf RF, Goodnight JE, Krag DE, et al. Results of resection and proposed guidelines for patient selection in instances of non-colorectal hepatic metastases. Surg Gynecol Obstet 1991;173:454–60

    PubMed  CAS  Google Scholar 

  31. Ahlman H, Wangberg B, Jansson S, et al. Interventional treatment of gastrointestinal neuroendocrine tumours. Digestion 2000;62(Suppl 1):59–68

    Article  PubMed  Google Scholar 

  32. Eriksson BK, Larsson EG, Skogseid BM, et al. Liver embolizations of patients with malignant neuroendocrine gastrointestinal tumors. Cancer 1998;83:2293–301

    Article  PubMed  CAS  Google Scholar 

  33. Brown KT, Koh BY, Brody LA, et al. Particle embolization of hepatic neuroendocrine metastases for control of pain and hormonal symptoms. J Vasc Interv Radiol 1999;10:397–403

    Article  PubMed  CAS  Google Scholar 

  34. Lehnert T. Liver transplantation for metastatic neuroendocrine carcinoma: an analysis of 103 patients. Transplantation 1998;66:1307–12

    Article  PubMed  CAS  Google Scholar 

  35. Zimmer T, Stozel U, Bader M, et al. Endoscopic ultrasonography and somatostatin receptor scintigraphy in the preoperative localisation of insulinomas and gastrinomas. Gut 1996;39:562–8

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Digestive Disorders Center, Tampa General Hospital, 1 Davis Island, Tampa, Florida, 33601

    Dana A. Osborne MD, Emmanuel E. Zervos MD, Brian A. Boe BS, Alexander S. Rosemurgy MD & Larry Carey MD

  2. Department of Clinical Investigation, GI Tumor Section, H. Lee Moffitt Cancer Center and Research Institute, 12901 Bruce B. Downs Boulevard, SRB 22134, Tampa, Florida, 33612

    Emmanuel E. Zervos MD, Jonathon Strosberg MD, Mokenge Malafa MD, Timothy J. Yeatman MD, Lisa Duhaine MD & Larry K. Kvols MD

Authors
  1. Dana A. Osborne MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Emmanuel E. Zervos MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jonathon Strosberg MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Brian A. Boe BS
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Mokenge Malafa MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Alexander S. Rosemurgy MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Timothy J. Yeatman MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Larry Carey MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Lisa Duhaine MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Larry K. Kvols MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Emmanuel E. Zervos MD.

Additional information

An erratum to this article is available at http://dx.doi.org/10.1245/ASO.2006.03.902.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Osborne, D.A., Zervos, E.E., Strosberg, J. et al. Improved Outcome With Cytoreduction Versus Embolization for Symptomatic Hepatic Metastases of Carcinoid and Neuroendocrine Tumors. Ann Surg Oncol 13, 572–581 (2006). https://doi.org/10.1245/ASO.2006.03.071

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/ASO.2006.03.071

Keywords

Search

Navigation