title: Surgery and radiofrequency ablation for treatment of liver metastases from midgut and foregut carcinoids and endocrine pancreatic tumors.
abstract: BACKGROUND
  Many neuroendocrine tumors (NETs) have a tendency to metastasize to the liver. In case of limited number of metastases, liver surgery or radiofrequency ablation (RFA) may result in apparently total clearance of metastases. However, it is not clear whether such therapy will provide symptom reduction or increased survival.
  
  
  METHODS
  Seventy-three patients with foregut (n=6) or midgut carcinoids (n=37) or endocrine pancreatic tumors (n=28), and two patients with NETs without discernable origin were studied. Symptoms were evaluated using a Symptom Severity Score. Liver surgery was performed in 42 operations and RFA on 205 lesions.
  
  
  RESULTS
  Apparently total clearance of liver metastases was attained in 1 of 6 patients with foregut carcinoids, 15 of 37 with midgut carcinoids, and 13 of 28 with EPT. Symptom improvement was noted in 12 of 17 (70.6%) patients with carcinoid syndrome, and 75% also reduced their 5-HIAA and P-CgA by at least 50%. Patients with nonfunctioning EPT generally had no improvement of symptoms after surgical/RFA liver treatment, but eight patients had functioning EPT, and four of these reduced their biochemical markers by at least 50%. NETs with higher Ki67 index tended to recur more often. Complications occurred in 9 of 45 open surgery procedures, and in 8 of 203 RFA procedures.
  
  
  CONCLUSIONS
  Treatment of liver metastases is successful in midgut carcinoid patients with limited liver metastases. Patients with foregut carcinoid and EPTs recur more often, possibly related to higher Ki67 index, and treatment of liver lesions less often reduces symptoms. Liver resections and RFA may be safely performed, and RFA is associated with few complications.
authors.affiliation: Department of Surgery, University Hospital, SE-751 85 Uppsala, Sweden.
authors.forename: John
authors.initials: J
authors.lastname: Eriksson
authors.forename: Peter
authors.initials: P
authors.lastname: Stålberg
authors.forename: Anders
authors.initials: A
authors.lastname: Nilsson
authors.forename: Johan
authors.initials: J
authors.lastname: Krause
authors.forename: Christina
authors.initials: C
authors.lastname: Lundberg
authors.forename: Britt
authors.initials: B
authors.lastname: Skogseid
authors.forename: Dan
authors.initials: D
authors.lastname: Granberg
authors.forename: Barbro
authors.initials: B
authors.lastname: Eriksson
authors.forename: Göran
authors.initials: G
authors.lastname: Akerström
authors.forename: Per
authors.initials: P
authors.lastname: Hellman
mesh_terms: D000328:Adult; D000368:Aged; D002276:Carcinoid Tumor / Q000556:secondary / Q000601:surgery*; D017115:Catheter Ablation; D015331:Cohort Studies; D005260:Female; D005770:Gastrointestinal Neoplasms / Q000473:pathology* / Q000601:surgery; D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000556:secondary / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000473:pathology* / Q000601:surgery; D012189:Retrospective Studies; D016896:Treatment Outcome