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Temporary liver dearterialization in patients with metastatic carcinoid disease

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Abstract

The surgical treatment of liver metastases from carcinoid tumors is burdened by a relatively poor symptomatic relief and a high mortality rate. Temporary liver dearterialization, separating the operative trauma from the temporary hepatic occlusion, may have advantages. We have utilized this treatment in 16 patients. The effect of treatment was registered in symptomatic relief, changes in urinary 5-HIAA, serotonin in platelet-poor plasma, and morphologic changes shown by angiography.

Fourteen patients, who underwent only the dearterialization procedure, survived the immediate postoperative period, while 2 patients who had concomitant small bowel resection both died of complications, 1 and 3 months postoperatively, respectively. One patient died, 14 months postoperatively, of the carcinoid disease. All but 1 patient were free from symptoms for at least 6 months. Two patients have had no recurrence of the carcinoid syndrome for 34 and 42 months, respectively. A decrease in urinary 5-HIAA was seen after 6 months in 10 patients, serotonin declined in 7 patients, and angiography showed regression in 7 patients. The results of this study indicate that temporary liver dearterialization is a safe procedure with low mortality and good symptomatic relief from the carcinoid syndrome.

Résumé

Le traitement chirurgical des métastases hépatiques des tumeurs carcinoÏdes n'entraÎne qu'une amélioration peu importante des manifestations symptomatiques. Il reste grevé d'une importante mortalité. La désartérélisation temporaire du foie pourrait en revanche présenter quelques avantages. Nous l' avons tentée chez 16 malades. L'effet du traitement fut jugé en fonction de l'amélioration des phénomènes symptomatiques, des modifications du taux des 5-HIAA urinaires, du taux de la sérotinine dans le plasma et des modifications morphologiques à l'angiographie.

14 patients qui ont été soumis à ce procédé thérapeutique ont survécus à l'opération, alors que 2 sont morts; le premier un mois et le second trois mois après l'opération qui avait comporté la résection de l'intestin. Sur les 14 survivants, un est mort 14 mois après l'opération de la généralisation du processus tumoral, 13 opérés n'ont présenté aucun symptome du moins pendant 6 mois, 2 n'ont présenté de récidive qu' après 34 et 42 mois respectivement. Une diminution dans le taux des 5-HIAA urinaires après 6 mois fut constatée chez 10 malades. Le taux de sérotinine s'abaissa chez 7 d'entre eux, cependant que l'angiographie montrait une régression des lésions chez également 7 de ces malades.

Les résultats de cette étude montrent que la désartérélisation temporaire du foie représente un procédé thérapeutique valable car la mortalité opératoire est faible et les symptomes dûs à l'origine carcinoÏde du processus tumoral régressent nettement.

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Authors and Affiliations

  1. Departments of Surgery and Diagnostic Radiology, University of Lund, Lund, Sweden

    S. Bengmark M.D., Ph.D., M. Ericsson M.D., Ph.D., A. Lunderquist M.D., Ph.D., H. Mårtensson M.D., A. Nobin M.D., Ph.D. & M. Sako M.D.

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  1. S. Bengmark M.D., Ph.D.
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  2. M. Ericsson M.D., Ph.D.
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  3. A. Lunderquist M.D., Ph.D.
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  4. H. Mårtensson M.D.
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  5. A. Nobin M.D., Ph.D.
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  6. M. Sako M.D.
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Supported by grants from the Swedish Medical Research Council (grant no. 04X-00712).

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Bengmark, S., Ericsson, M., Lunderquist, A. et al. Temporary liver dearterialization in patients with metastatic carcinoid disease. World J. Surg. 6, 46–53 (1982). https://doi.org/10.1007/BF01656372

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