Management of hepatic metastasis of gastrointestinal carcinoid tumors.
BACKGROUND
Hepatic resection, radiofrequency ablation, intra-arterial radiation therapy, and chemoembolization are all potential therapies in the treatment of metastatic carcinoid tumors of the liver. The aim of this study was to determine the prognostic factors in the management of hepatic metastases of gastrointestinal carcinoid tumors.


METHODS
We reviewed our prospective database of 1084 hepato-pancreatico-biliary patients for patients with the diagnosis of metastatic carcinoid to the liver from 6/1998 to 9/2006.


RESULTS
We identified 54 patients, 21 men, 33 women, median age 59 years (range 37-86), median number of tumors 3 (range 1-27), and median size of hepatic metastasis of 4 cm (range 1-13). Hepatic resection was performed in 23 (43%) with 16 (70%) receiving additional hepatic directed therapy. Hepatic resection was found to have a statistically significant improved overall survival (P < 0.05) when compared to nonhepatic resection patients with an actuarial 5 years survival for surgical (75%) compared to nonsurgical (62%). Multivariate analysis demonstrated that the use of tobacco was a significant factor in poor overall outcome (P = 0.005).


CONCLUSIONS
Multimodality therapy in the management of hepatic carcinoid metastasis can be done safely and effectively. We recommend the use of hepatic resection when feasible as this treatment most likely offers the best long-term outcome.
Landry
Christine S
CS
Department of Surgery, Division of Surgical Oncology, James Graham Brown Cancer Center, University of Louisville School of Medicine, Louisville, Kentucky 40202, USA.
Scoggins
Charles R
CR
McMasters
Kelly M
KM
Martin
Robert C G
RC
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002276:Carcinoid Tumor / Q000401:mortality / Q000556:secondary* / Q000628:therapy*; D015331:Cohort Studies; D003131:Combined Modality Therapy; D016208:Databases, Factual; D005260:Female; D005770:Gastrointestinal Neoplasms / Q000401:mortality / Q000473:pathology*; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality / Q000556:secondary* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome