TREATMENT OF LIVER METASTASES OF CARCINOID-TUMORS

Liver metastases imply a major problem in patients with carcinoid tumo rs. Patients with localized disease should always undergo resection fo r cure. Patients with distant metastatic disease can also undergo rese ction for potential cure or symptom palliation because of the slow gro wth rate of many carcinoid tumors. In patients with the midgut carcino id syndrome and bilobar hepatic disease we have performed primary surg ery to relieve such symptoms as intestinal obstruction and ischemia, f ollowed by successive embolizations of the hepatic arteries to reduce functional tumor burden in the liver. For optimal palliation, all pati ents with residual tumor were treated by octreotide. In a consecutive series of 64 patients with the midgut carcinoid syndrome we thus attai ned a 5-year survival rate of 70%. Fourteen of the patients underwent intentionally curative surgery (e.g., primary surgery followed by live r surgery). Of these patients, none died from their tumor disease duri ng the period of study. The value of adjunctive interferon therapy is currently under evaluation.