title: Results of liver transplantation in the treatment of metastatic neuroendocrine tumors. A 31-case French multicentric report.
abstract: OBJECTIVE
  The purpose of this study was to assess the value and timing of orthotopic liver transplantation (OLT) in the treatment of metastatic neuroendocrine tumors (NET).
  
  
  BACKGROUND
  Liver metastasis from NET seems less invasive than other secondary tumors. This observation suggests that OLT may be indicated when other therapies become ineffective. However, the potential benefit of this highly aggressive procedure is difficult to assess due to the scarcity and heterogeneity of NET.
  
  
  METHODS
  A retrospective multicentric study was carried out, including all cases of OLT for NET performed in France between 1989 and 1994. There were 15 cases of metastatic carcinoid tumor and 16 cases of islet cell carcinomas. Hormone-related symptoms were present in 16 cases (55%). Only 5 patients (16%) had no previous surgical or medical therapy before OLT. Median delay from diagnosis of liver metastasis and OLT was 19 months (range, 2 to 120).
  
  
  RESULTS
  The primary tumor was removed at the time of OLT in 11 cases, by upper abdominal exenteration in 7 cases and the Whipple resection in 3. Actuarial survival rate after OLT was 59% at 1 year, 47% at 3 years, and 36% at 5 years. Survival rates were significantly higher for metastatic carcinoid tumors (69% at 5 years) than for noncarcinoid apudomas (8% at 4 years), because of higher tumor- and non-tumor-related mortality rates for the latter.
  
  
  CONCLUSIONS
  OLT can achieve control of hormonal symptoms and prolong survival in selected patients with liver metastasis of carcinoid tumors. It does not seem indicated for other NET.
authors.affiliation: Department of Surgery, Hopital de La Conception, Marseilles, France.
authors.forename: Y P
authors.initials: YP
authors.lastname: Le Treut
authors.forename: J R
authors.initials: JR
authors.lastname: Delpero
authors.forename: B
authors.initials: B
authors.lastname: Dousset
authors.forename: D
authors.initials: D
authors.lastname: Cherqui
authors.forename: P
authors.initials: P
authors.lastname: Segol
authors.forename: G
authors.initials: G
authors.lastname: Mantion
authors.forename: L
authors.initials: L
authors.lastname: Hannoun
authors.forename: G
authors.initials: G
authors.lastname: Benhamou
authors.forename: B
authors.initials: B
authors.lastname: Launois
authors.forename: O
authors.initials: O
authors.lastname: Boillot
authors.forename: J
authors.initials: J
authors.lastname: Domergue
authors.forename: H
authors.initials: H
authors.lastname: Bismuth
mesh_terms: D000328:Adult; D005260:Female; D005602:France; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality / Q000556:secondary* / Q000601:surgery*; D016031:Liver Transplantation / Q000379:methods; D008297:Male; D008875:Middle Aged; D018358:Neuroendocrine Tumors / Q000401:mortality / Q000556:secondary* / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D015996:Survival Rate; D013997:Time Factors