BACKGROUND: Hepatic resection of metastatic carcinoid cancer can prolong survival and control symptomatic endocrinopathy. Decompensated carcinoid heart disease (CHD) can develop in some patients with metastatic carcinoid cancers, which can preclude operation for resectable hepatic metastases. We hypothesized that outcomes after hepatic resection for patients with the carcinoid syndrome after valve replacement for CHD would be similar to carcinoid patients without CHD. STUDY DESIGN: We compared the survival and symptom control after hepatic resection for patients undergoing valve replacement for CHD to carcinoid patients without CHD matched for age, sex, and extent of hepatectomy. RESULTS: Fourteen patients with earlier valve replacement for CHD were compared with 28 carcinoid patients without CHD. All patients had hepatic resection for metastatic carcinoid disease and carcinoid syndrome. Mean age, sex distribution, and extent of hepatectomy (major hepatectomy, 78%) was similar between groups. Mean interval from valve replacement to hepatectomy was 101 days. There was no operative mortality. Major operative morbidity, inclusive of operative blood loss and cardiorespiratory events, occurred in 28.5% and 14.2% for CHD and non-CHD groups, respectively (p = 0.16). Symptom-free survival for CHD and non-CHD groups was 69% and 81% at 1 year (p = 0.22) and 61% and 44% (p = 0.17) at 5 years, respectively. Octreotide-free survival after hepatectomy 69% and 84% (p = 0.15) at 1 year and 62% and 52% (p = 0.29) 5 years, respectively. Overall survival CHD and non-CHD groups 100% at 1 year and 100% and 70% (p = 0.002) 5 years. CONCLUSIONS: Valve replacement for severe CHD is safe and hepatic resection is associated with similar outcomes as patients without CHD undergoing hepatic resection for carcinoid syndrome. Identifying resectable hepatic metastases from carcinoids in patients with severe CHD should prompt valve replacement and interval hepatic resection.
BACKGROUND: Hepatic resection of metastatic carcinoid cancer can prolong survival and control symptomatic endocrinopathy. Decompensated carcinoid heart disease (CHD) can develop in some patients with metastatic carcinoid cancers, which can preclude operation for resectable hepatic metastases. We hypothesized that outcomes after hepatic resection for patients with the carcinoid syndrome after valve replacement for CHD would be similar to carcinoidpatients without CHD. STUDY DESIGN: We compared the survival and symptom control after hepatic resection for patients undergoing valve replacement for CHD to carcinoidpatients without CHD matched for age, sex, and extent of hepatectomy. RESULTS: Fourteen patients with earlier valve replacement for CHD were compared with 28 carcinoidpatients without CHD. All patients had hepatic resection for metastatic carcinoid disease and carcinoid syndrome. Mean age, sex distribution, and extent of hepatectomy (major hepatectomy, 78%) was similar between groups. Mean interval from valve replacement to hepatectomy was 101 days. There was no operative mortality. Major operative morbidity, inclusive of operative blood loss and cardiorespiratory events, occurred in 28.5% and 14.2% for CHD and non-CHD groups, respectively (p = 0.16). Symptom-free survival for CHD and non-CHD groups was 69% and 81% at 1 year (p = 0.22) and 61% and 44% (p = 0.17) at 5 years, respectively. Octreotide-free survival after hepatectomy 69% and 84% (p = 0.15) at 1 year and 62% and 52% (p = 0.29) 5 years, respectively. Overall survival CHD and non-CHD groups 100% at 1 year and 100% and 70% (p = 0.002) 5 years. CONCLUSIONS: Valve replacement for severe CHD is safe and hepatic resection is associated with similar outcomes as patients without CHD undergoing hepatic resection for carcinoid syndrome. Identifying resectable hepatic metastases from carcinoids in patients with severe CHD should prompt valve replacement and interval hepatic resection.
Authors: E A Hart; T A Meijs; R C A Meijer; K M Dreijerink; M E Tesselaar; C A de Groot; G D Valk; S A J Chamuleau Journal: Neth Heart J Date: 2017-09 Impact factor: 2.380
Authors: Husnain Abbas Shah; Vandana Sagar; Simon Hughes; Amardeep Khanna; Ivan Yim; Freya Lodge; Harjot Singh; Tessa Oelofse; Críostóir Ó'Súilleabháin; Hema Venkataraman; Shishir Shetty; Richard Steeds; Stephen Rooney; Tahir Shah Journal: Front Surg Date: 2022-04-08
Authors: Simona Grozinsky-Glasberg; Joseph Davar; Johannes Hofland; Rebecca Dobson; Vikas Prasad; Andreas Pascher; Timm Denecke; Margot E T Tesselaar; Francesco Panzuto; Anders Albåge; Heidi M Connolly; Jean-Francois Obadia; Rachel Riechelmann; Christos Toumpanakis Journal: J Neuroendocrinol Date: 2022-05-25 Impact factor: 3.870
Authors: Rebecca Dobson; Malcolm I Burgess; Melissa Banks; D Mark Pritchard; Jiten Vora; Juan W Valle; Christopher Wong; Carrie Chadwick; Keith George; Brian Keevil; Joanne Adaway; Joy E S Ardill; Alan Anthoney; Uschi Hofmann; Graeme J Poston; Daniel J Cuthbertson Journal: PLoS One Date: 2013-09-12 Impact factor: 3.240