Hepatic resection for the carcinoid syndrome in patients with severe carcinoid heart disease: Does valve replacement permit safe hepatic resection?

Joseph B. Lillegard, James E. Fisher, Travis J. McKenzie, Florencia Que, Michael B. Farnell, Michael L. Kendrick, John H. Donohue, Kaye Reid-Lombardo, Hartzell V Schaff, Heidi M. Connolly, David M. Nagorney

Research output: Contribution to journalArticle

16 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)130-136
Number of pages7
JournalJournal of the American College of Surgeons
Volume213
Issue number1
DOIs
StatePublished - Jul 2011

Fingerprint

Carcinoid Heart Disease
Carcinoid Tumor
Liver
Hepatectomy
Survival
Heart Diseases
Neoplasm Metastasis
Sex Distribution
Octreotide
Age Distribution

ASJC Scopus subject areas

  • Surgery

Cite this

Hepatic resection for the carcinoid syndrome in patients with severe carcinoid heart disease : Does valve replacement permit safe hepatic resection? / Lillegard, Joseph B.; Fisher, James E.; McKenzie, Travis J.; Que, Florencia; Farnell, Michael B.; Kendrick, Michael L.; Donohue, John H.; Reid-Lombardo, Kaye; Schaff, Hartzell V; Connolly, Heidi M.; Nagorney, David M.

In: Journal of the American College of Surgeons, Vol. 213, No. 1, 07.2011, p. 130-136.

Research output: Contribution to journalArticle

Lillegard, Joseph B. ; Fisher, James E. ; McKenzie, Travis J. ; Que, Florencia ; Farnell, Michael B. ; Kendrick, Michael L. ; Donohue, John H. ; Reid-Lombardo, Kaye ; Schaff, Hartzell V ; Connolly, Heidi M. ; Nagorney, David M. / Hepatic resection for the carcinoid syndrome in patients with severe carcinoid heart disease : Does valve replacement permit safe hepatic resection?. In: Journal of the American College of Surgeons. 2011 ; Vol. 213, No. 1. pp. 130-136.
@article{f227d44fae9c4228ad724dbdbfab611b,
title = "Hepatic resection for the carcinoid syndrome in patients with severe carcinoid heart disease: Does valve replacement permit safe hepatic resection?",
abstract = "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.",
author = "Lillegard, {Joseph B.} and Fisher, {James E.} and McKenzie, {Travis J.} and Florencia Que and Farnell, {Michael B.} and Kendrick, {Michael L.} and Donohue, {John H.} and Kaye Reid-Lombardo and Schaff, {Hartzell V} and Connolly, {Heidi M.} and Nagorney, {David M.}",
year = "2011",
month = "7",
doi = "10.1016/j.jamcollsurg.2011.03.029",
language = "English (US)",
volume = "213",
pages = "130--136",
journal = "Journal of the American College of Surgeons",
issn = "1072-7515",
publisher = "Elsevier Inc.",
number = "1",

}

TY - JOUR

T1 - Hepatic resection for the carcinoid syndrome in patients with severe carcinoid heart disease

T2 - Does valve replacement permit safe hepatic resection?

AU - Lillegard, Joseph B.

AU - Fisher, James E.

AU - McKenzie, Travis J.

AU - Que, Florencia

AU - Farnell, Michael B.

AU - Kendrick, Michael L.

AU - Donohue, John H.

AU - Reid-Lombardo, Kaye

AU - Schaff, Hartzell V

AU - Connolly, Heidi M.

AU - Nagorney, David M.

PY - 2011/7

Y1 - 2011/7

N2 - 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.

AB - 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.

UR - http://www.scopus.com/inward/record.url?scp=79959527101&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=79959527101&partnerID=8YFLogxK

U2 - 10.1016/j.jamcollsurg.2011.03.029

DO - 10.1016/j.jamcollsurg.2011.03.029

M3 - Article

C2 - 21493110

AN - SCOPUS:79959527101

VL - 213

SP - 130

EP - 136

JO - Journal of the American College of Surgeons

JF - Journal of the American College of Surgeons

SN - 1072-7515

IS - 1

ER -