Long-term survival after diagnosis of hepatic metastatic VIPoma - Report of two cases with disparate courses and review of therapeutic options

This report describes two patients with pancreatic cholera caused by vasoac tive intestinal polypeptide (VIP)-producing tumors, which originated in the pancreas and showed metastases in both hepatic lobes at time of diagnosis. However, the two tumors displayed remarkably disparate clinical courses. D ue to the protracted but progressive course over more than 10 years, a mult ifaceted therapeutic approach was performed to control symptoms and to impr ove quality of life. The long-acting somatostatin analog octreotide was the most effective treatment for relieving symptoms and correcting fluid and e lectrolytes disturbances, The effects of complementary treatments, includin g systemic chemotherapy and hyperselective chemoembolization, as well as co ncurrent application of octreotide and prednisolone or interferon with resp ect to clinical symptoms, VIP levels, and tumor growth are reviewed. Our ex perience, although small, emphasizes the need for an expert, well-planned, adaptive, and multidisciplinary approach in the care of these complex patie nts.