RESULTS OF LIVER-TRANSPLANTATION IN THE TREATMENT OF METASTATIC NEUROENDOCRINE TUMORS - A 31-CASE FRENCH MULTICENTRIC REPORT

Objective The purpose of this study was to assess the value and timing of orthotopic liver transplantation (OLT) in the treatment of metasta tic neuroendocrine tumors (NET). Summary Background Data Liver metasta sis from NET seems less invasive than other secondary tumors. This obs ervation suggests that OLT may be indicated when other therapies becom e ineffective. However, the potential benefit of this highly aggressiv e procedure is difficult to assess due to the scarcity and heterogenei ty of NET. Methods A retrospective multicentric study was carried out, including ail cases of OLT for NET performed in France between 1989 a nd 1994. There were 15 cases of metastatic carcinoid tumor and 16 case s of islet cell carcinomas. Hormone-related symptoms were present in 1 6 cases (55%). Only 5 patients (16%) had no previous surgical or medic al therapy before OLT. Median delay from diagnosis of liver metastasis and OLT was 19 months (range, 2 to 120). Results The primary tumor wa s removed at the time of OLT in 11 cases, by upper abdominal exenterat ion in 7 cases and the Whipple resection in 3. Actuarial survival rate after OLT was 59% at 1 year, 47% at 3 years, and 36% at 5 years. Surv ival rates were significantly higher for metastatic carcinoid tumors ( 69% at 5 years) than for noncarcinoid apudomas (8% at 4 years), becaus e oi higher tumor- and non-tumor-related mortality rates for the latte r. Conclusion OLT can achieve control of hormonal symptoms and prolong survival in selected patients with liver metastasis of carcinoid tumo rs. ii does not seem indicated for other NET.