American Association of Endocrine SurgeonsExpanded criteria for carcinoid liver debulking: Maintaining survival and increasing the number of eligible patients
Section snippets
Methods
Records of patients with carcinoid undergoing liver debulking by a single surgeon for the indications of improving symptoms and/or survival from January 2007 to December 2011 were reviewed. Data collected included age; sex; primary tumor site; functional status of the tumor; preoperative and postoperative use of octreotide; other treatments of liver metastases; number, location, and size of tumors resected; sites of extrahepatic disease; resection of extrahepatic disease; percentage of hepatic
Results
Fifty-two patients were identified. Patient characteristics are shown in Table I. After exploration at the time of liver resection, the primary tumor was localized in all but three patients. Thirty-seven patients received octreotide long-acting repeatable (LAR) as outpatients before resection; 88% of patients were maintained on octreotide LAR postoperatively. Liver-directed therapy had been used in seven patients before liver debulking; three had undergone liver radiofrequency ablation (RFA),
Discussion
Liver debulking criteria for patients with NETs have not been clearly defined. Generally, a debulking threshold of >90% of liver tumor burden has been accepted.10 An important finding within that cohort is that the 5-year survival rate for those with functional tumors who undergo either complete or incomplete resection is indistinguishable from that of patients with nonfunctional tumors who undergo complete resection (60% vs 61%).10 Others have reported 5-year survival rates of greater than 70%
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2023, Surgical Oncology Clinics of North AmericaCitation Excerpt :Importantly, the studies that have evaluated thresholds of cytoreduction for patients with NETLM did not show any improvements in PFS or OS when the threshold of >70% was compared with thresholds of 90% to 99% and 100%.13,61,62 Factors that have been identified as negative predictive factors for PFS and OS in patients with NETLM are age <50, liver metastases ≥ 5 cm, the presence of synchronous disease at the primary site, extrahepatic disease at the time of liver resection, and NF hormone status.10,59,63 Scott and colleagues61 validated the debulking threshold of 70% and showed that aggressive debulking can be achieved even in patients with >10 liver metastases.
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2022, American Journal of SurgeryCitation Excerpt :This makes a strong argument for performing valve replacement operations in patients with CHD and inoperable liver metastases. Surgical cytoreduction of hepatic metastases has emerged as an important advance in the treatment of carcinoid disease.11,13,14 Bernheim et al.23 reported 31 patients with CHD who underwent hepatic cytoreduction.
Sources of financial support: OHSU Carcinoid Research Foundation.
Dr R. Pommier serves as a consultant for Novartis Oncology Pharmaceuticals and Pfizer, Inc.