Outcome of Liver Resection for Carcinoid Neuroendocrine Metastases
Polkinghorne, M.D.; Krige, J.E.J.; Jonas, E.; Kotze, U.K.; Bernon, M.M.
South African Journal of Surgery. Suid-Afrikaanse Tydskrif Vir Chirurgie 55(2): 50-51
2017
ISSN/ISBN: 0038-2361 PMID: 28876642 Document Number: 691537
Gastrointestinal carcinoid tumours, despite their low malignant potential, frequently metastasize to the liver. While liver resection improves survival and provides symptomatic relief, multifocal bilobar disease complicates surgical management. All patients with carcinoid liver secondaries managed by resection from 1990-2015 were identified from a prospective departmental database. Demographic data, operative management, morbidity using the Accordion classification and mortality were analysed. Survival was assessed using the Kaplan-Meier method. Seventeen patients (9 women, 8 men, median age 55 years, range 31-76) underwent resection. Median number of liver secondaries treated was 3 (range 1-20). Ten patients had major anatomical liver resections. Three patients had 5 segments resected, seven had 4 resected, and seven had ≤ 2 resected. Each patient had all identifiable liver secondaries resected or ablated. Two also had intraoperative tumour ablation. Nine patients (53%) had a concurrent bowel resection and lymphadenectomy. Median operating time was 255 minutes (range 150-720). Median blood-loss was 800 ml (range 200-10,000). Five patients required intraoperative blood transfusion. Intermittent portal inflow occlusion (56.5 minutes median, range 20-150 minutes) was used in 8 patients. Median postoperative hospital stay was 9 days (range 2-28). Thirteen complications occurred in seven patients. Accordion grade 1 complications were n = 3 (ileus, wound sepsis, confusion), grade 2 n = 4 (delayed gastric emptying, pleural effusion, wound sepsis), grade 3 n = 3 (bile leak, intra-abdominal collection, atelectasis), grade 4 n = 2 (intra-operative bleeding) and grade 6 n = 1 (cardiac failure). One patient required reoperation for bleeding and a bile leak. One patient died of a myocardial infarction 36 hours postoperatively. Sixteen (94%) patients had symptomatic improvement. Five-year actuarial survival-rate was 91% (median follow-up 36 months, range 14-86 months). Our data show that liver resection can be safely performed for carcinoid secondaries with a good 5-year survival. However, a substantial number of patients require a major liver resection and are best treated at a multidisciplinary referral centre.