title: Survival and functional quality of life after resection for hepatic carcinoid metastasis.
abstract: Retrospective studies suggest that resection improves 5-year survival for patients with hepatic carcinoid metastasis (HCM). The purpose of our study was to describe clinical outcomes following resection for HCM, including survival and longitudinal functional quality of life (QOL). We reviewed the records of patients undergoing resection for HCM from 1980 to 2001 at our institution. Outcome measures included tumor symptoms, biochemical tumor markers, functional QOL through Karnofsky functional scores, and survival. Thirteen patients underwent a total of 17 resections. Overall 5-year survival was 85%. Eleven patients were symptomatic, including eight with classic carcinoid syndrome. Nine experienced complete relief of symptoms and two had incomplete relief for 30 +/- 12 months. Eight patients had elevated tumor markers, and 50% of these had postoperative normalization of all tumor markers that persisted to the close of the study. For the 10 patients with longitudinal follow-up available to 54 months, significant improvement in functional QOL was observed at all follow-up time points compared to preresection functional QOL (P < 0.05). Resection of >/=90% tumor volume was significantly associated with more favorable survival and tumor marker normalization compared to resection of <90% tumor volume (P < 0.01 and P < 0.05, respectively), but trajectory of functional QOL improvement did not differ between these two groups (P=0.24). We conclude that resection for HCM is associated with significantly improved and sustained functional QOL and prolonged survival. Resection of >/=90% tumor volume is significantly associated with extended survival and normalization of tumor markers, but is not required for symptomatic or functional QOL improvement.
authors.affiliation: Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee 37232-4753, USA. clayton.d.knox@vanderbilt.edu
authors.forename: Clayton D
authors.initials: CD
authors.lastname: Knox
authors.forename: Irene D
authors.initials: ID
authors.lastname: Feurer
authors.forename: Paul E
authors.initials: PE
authors.lastname: Wise
authors.forename: Laura W
authors.initials: LW
authors.lastname: Lamps
authors.forename: J
authors.initials: J
authors.lastname: Kelly Wright
authors.forename: Ravi S
authors.initials: RS
authors.lastname: Chari
authors.forename: D
authors.initials: D
authors.lastname: Lee Gorden
authors.forename: C
authors.initials: C
authors.lastname: Wright Pinson
mesh_terms: D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D002276:Carcinoid Tumor / Q000401:mortality / Q000556:secondary* / Q000601:surgery*; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality / Q000556:secondary* / Q000601:surgery*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D012189:Retrospective Studies; D016019:Survival Analysis