Role of hepatic resection for patients with carcinoid heart disease

Alain M. Bernheim, Heidi M. Connolly, Joseph Rubin, Jacob E. Møller, Christopher G. Scott, David M. Nagorney, Patricia Pellikka

Research output: Contribution to journalArticle

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Abstract

OBJECTIVE: To evaluate the effects of resection of hepatic carcinoid metastases on progression and prognosis of carcinoid heart disease. PATIENTS AND METHODS: From our database of 265 consecutive patients diagnosed as having carcinoid heart disease from January 1, 1980, through December 31, 2005, we calculated survival from first diagnosis of cardiac involvement. Hepatic resection during follow-up was entered as a time-dependent covariable in a multivariable analysis. In patients with serial echocardiograms more than 1 year apart without intervening cardiac surgery, a previously validated cardiac severity score was calculated. A score increase that exceeded 25% was considered relevant progression. RESULTS: Hepatic resection was performed in 31 patients (12%) during follow-up. Five-year survival was significantly higher in these patients (86.5%; 95% confidence interval [CI], 73.5%-100.0%) than in patients without hepatic resection (29.0%; 95% CI, 23.3%-36.1%; univariable hazard ratio for hepatic resection, 0.25; 95% CI 0.12-0.53; P<.001). Hepatic resection remained strongly associated with improved prognosis in multivariable analysis (hazard ratio, 0.31; 95% CI, 0.14-0.66; P=.003). Among 77 patients (29%) with serial echocardiograms, 10 (13%) underwent hepatic resection during follow-up; resection was independently associated with decreased risk of cardiac progression (odds ratio, 0.29; 95% CI, 0.06-0.75; P=.03). CONCLUSION: Despite the limitations of this retrospective nonrandomized study, our data suggest that patients with carcinoid heart disease who undergo hepatic resection have decreased cardiac progression and improved prognosis. Eligible patients should be considered for hepatic surgery.

Original languageEnglish (US)
Pages (from-to)143-150
Number of pages8
JournalMayo Clinic Proceedings
Volume83
Issue number2
DOIs
StatePublished - 2008

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Carcinoid Heart Disease
Liver
Confidence Intervals
Survival
Carcinoid Tumor
Thoracic Surgery
Retrospective Studies
Odds Ratio

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Bernheim, A. M., Connolly, H. M., Rubin, J., Møller, J. E., Scott, C. G., Nagorney, D. M., & Pellikka, P. (2008). Role of hepatic resection for patients with carcinoid heart disease. Mayo Clinic Proceedings, 83(2), 143-150. https://doi.org/10.4065/83.2.143

Role of hepatic resection for patients with carcinoid heart disease. / Bernheim, Alain M.; Connolly, Heidi M.; Rubin, Joseph; Møller, Jacob E.; Scott, Christopher G.; Nagorney, David M.; Pellikka, Patricia.

In: Mayo Clinic Proceedings, Vol. 83, No. 2, 2008, p. 143-150.

Research output: Contribution to journalArticle

Bernheim, AM, Connolly, HM, Rubin, J, Møller, JE, Scott, CG, Nagorney, DM & Pellikka, P 2008, 'Role of hepatic resection for patients with carcinoid heart disease', Mayo Clinic Proceedings, vol. 83, no. 2, pp. 143-150. https://doi.org/10.4065/83.2.143
Bernheim AM, Connolly HM, Rubin J, Møller JE, Scott CG, Nagorney DM et al. Role of hepatic resection for patients with carcinoid heart disease. Mayo Clinic Proceedings. 2008;83(2):143-150. https://doi.org/10.4065/83.2.143
Bernheim, Alain M. ; Connolly, Heidi M. ; Rubin, Joseph ; Møller, Jacob E. ; Scott, Christopher G. ; Nagorney, David M. ; Pellikka, Patricia. / Role of hepatic resection for patients with carcinoid heart disease. In: Mayo Clinic Proceedings. 2008 ; Vol. 83, No. 2. pp. 143-150.
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N2 - OBJECTIVE: To evaluate the effects of resection of hepatic carcinoid metastases on progression and prognosis of carcinoid heart disease. PATIENTS AND METHODS: From our database of 265 consecutive patients diagnosed as having carcinoid heart disease from January 1, 1980, through December 31, 2005, we calculated survival from first diagnosis of cardiac involvement. Hepatic resection during follow-up was entered as a time-dependent covariable in a multivariable analysis. In patients with serial echocardiograms more than 1 year apart without intervening cardiac surgery, a previously validated cardiac severity score was calculated. A score increase that exceeded 25% was considered relevant progression. RESULTS: Hepatic resection was performed in 31 patients (12%) during follow-up. Five-year survival was significantly higher in these patients (86.5%; 95% confidence interval [CI], 73.5%-100.0%) than in patients without hepatic resection (29.0%; 95% CI, 23.3%-36.1%; univariable hazard ratio for hepatic resection, 0.25; 95% CI 0.12-0.53; P<.001). Hepatic resection remained strongly associated with improved prognosis in multivariable analysis (hazard ratio, 0.31; 95% CI, 0.14-0.66; P=.003). Among 77 patients (29%) with serial echocardiograms, 10 (13%) underwent hepatic resection during follow-up; resection was independently associated with decreased risk of cardiac progression (odds ratio, 0.29; 95% CI, 0.06-0.75; P=.03). CONCLUSION: Despite the limitations of this retrospective nonrandomized study, our data suggest that patients with carcinoid heart disease who undergo hepatic resection have decreased cardiac progression and improved prognosis. Eligible patients should be considered for hepatic surgery.

AB - OBJECTIVE: To evaluate the effects of resection of hepatic carcinoid metastases on progression and prognosis of carcinoid heart disease. PATIENTS AND METHODS: From our database of 265 consecutive patients diagnosed as having carcinoid heart disease from January 1, 1980, through December 31, 2005, we calculated survival from first diagnosis of cardiac involvement. Hepatic resection during follow-up was entered as a time-dependent covariable in a multivariable analysis. In patients with serial echocardiograms more than 1 year apart without intervening cardiac surgery, a previously validated cardiac severity score was calculated. A score increase that exceeded 25% was considered relevant progression. RESULTS: Hepatic resection was performed in 31 patients (12%) during follow-up. Five-year survival was significantly higher in these patients (86.5%; 95% confidence interval [CI], 73.5%-100.0%) than in patients without hepatic resection (29.0%; 95% CI, 23.3%-36.1%; univariable hazard ratio for hepatic resection, 0.25; 95% CI 0.12-0.53; P<.001). Hepatic resection remained strongly associated with improved prognosis in multivariable analysis (hazard ratio, 0.31; 95% CI, 0.14-0.66; P=.003). Among 77 patients (29%) with serial echocardiograms, 10 (13%) underwent hepatic resection during follow-up; resection was independently associated with decreased risk of cardiac progression (odds ratio, 0.29; 95% CI, 0.06-0.75; P=.03). CONCLUSION: Despite the limitations of this retrospective nonrandomized study, our data suggest that patients with carcinoid heart disease who undergo hepatic resection have decreased cardiac progression and improved prognosis. Eligible patients should be considered for hepatic surgery.

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