title: Indications and results of liver resection and hepatic chemoembolization for metastatic gastrointestinal neuroendocrine tumors.
abstract: BACKGROUND
  We reviewed 36 patients with liver metastases from islet cell tumors of the pancreas (n = 18) and carcinoid tumors (n = 18) who were treated with surgical resection (n = 16) or hepatic chemoembolization (n = 20).
  
  
  METHODS
  All resections were complete and included 4 lobectomies, 6 segmental resections, and 6 wedge resections. There were no operative deaths.
  
  
  RESULTS
  Median survival has not yet been reached, and the actuarial 5-year survival rate is 70%. Prognostic variables associated with improved disease-free survival included prior resection of the primary tumor and 4 or fewer metastases resected (P <.05). With an average of 3 chemoembolization procedures per patient, 17 of 20 patients (90%) demonstrated either a significant radiographic response (n = 5), stabilization of tumor mass (n = 2), or improvement of clinical symptoms (n = 10). Factors related to a sustained response (more then 1 year) included surgical resection of the primary tumor, 4 or more chemoembolization procedures, and liver metastases of 5 cm or smaller. Median survival after treatment was 32 months (range, 7-63 months), and the actuarial 5-year survival rate was 40%.
  
  
  CONCLUSIONS
  Surgical resection of metastatic neuroendocrine tumors provides the best chance for extended survival. Chemoembolization effectively improves clinical symptoms and, in selected patients, may provide sustained tumor control.
authors.affiliation: Department of Surgery, Northwestern University Medical School, Chicago, Ill 60611, USA.
authors.forename: K A
authors.initials: KA
authors.lastname: Yao
authors.forename: M S
authors.initials: MS
authors.lastname: Talamonti
authors.forename: A
authors.initials: A
authors.lastname: Nemcek
authors.forename: P
authors.initials: P
authors.lastname: Angelos
authors.forename: H
authors.initials: H
authors.lastname: Chrisman
authors.forename: J
authors.initials: J
authors.lastname: Skarda
authors.forename: A B
authors.initials: AB
authors.lastname: Benson
authors.forename: S
authors.initials: S
authors.lastname: Rao
authors.forename: R J
authors.initials: RJ
authors.lastname: Joehl
mesh_terms: D007516:Adenoma, Islet Cell / Q000628:therapy*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002276:Carcinoid Tumor / Q000628:therapy*; D016461:Chemoembolization, Therapeutic; D003131:Combined Modality Therapy; D005260:Female; D005770:Gastrointestinal Neoplasms / Q000628:therapy*; D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality / Q000556:secondary* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000628:therapy*; D015996:Survival Rate