title: Palliative management strategies of advanced gastrointestinal carcinoid neoplasms.
abstract: OBJECTIVE
  Optimal management of gastrointestinal carcinoid neoplasms that metastasize to the liver is controversial. Although operative resection seems to be the most effective approach to metastatic disease, hepatic metastases are usually multicentric and often non-resectable. We investigated the effectiveness of several forms of palliative tumor cytoreduction followed by administration of somatostatin analogues in advanced carcinoid neoplasms.
  
  
  METHODS
  We reviewed our experience with 34 patients with gastrointestinal carcinoid neoplasms. Eighteen patients had metastases and 14 had hormonal symptoms. Twenty-two patients underwent radical surgery, ten with multiple liver metastases were treated with a combination of debulking (resection, radiofrequency ablation, chemoembolization), followed by medical treatment with long-acting octreotide and eventually by radiolabelled somatostatin analogues, and two patients with intractable disease received only biotherapies.
  
  
  RESULTS
  The six patients with metastatic disease who underwent radical curative liver resection had a median survival of 52 months, compared with a median survival of 48 months in the ten patients who underwent palliative debulking. Symptomatic improvement was observed in all the patients after debulking procedures. The two patients who underwent only medical treatment died after 9 and 18 months.
  
  
  CONCLUSIONS
  Aggressive tumor debulking should be performed in patients with liver metastases already at diagnosis even when complete resection is not feasible because the combination of cytoreductive procedures followed by biotherapies may provide good long-term survival and achieves symptom control in most patients with advanced disease.
authors.affiliation: Department of Surgery, San Gerardo Hospital, University of Milan-Bicocca, Monza, Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: Sartori
authors.forename: Chiara
authors.initials: C
authors.lastname: Mussi
authors.forename: Carlo
authors.initials: C
authors.lastname: Angelini
authors.forename: Stefano
authors.initials: S
authors.lastname: Crippa
authors.forename: Roberto
authors.initials: R
authors.lastname: Caprotti
authors.forename: Franco
authors.initials: F
authors.lastname: Uggeri
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use; D002276:Carcinoid Tumor / Q000556:secondary* / Q000601:surgery* / Q000628:therapy; D005260:Female; D005770:Gastrointestinal Neoplasms / Q000473:pathology* / Q000601:surgery; D006801:Humans; D008113:Liver Neoplasms / Q000556:secondary* / Q000601:surgery* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D015282:Octreotide / Q000031:analogs & derivatives / Q000627:therapeutic use; D010166:Palliative Care; D019275:Radiopharmaceuticals / Q000627:therapeutic use; D015019:Yttrium
chemical_list: D000970:Antineoplastic Agents; D019275:Radiopharmaceuticals; D015019:Yttrium; D015282:Octreotide; C106246:Edotreotide