Outcomes of liver resections for neuroendocrine tumor liver metastases in carcinoid heart disease
Markus Ammann, Hallbera Gudmundsdottir, Vanja Podrascanin, Jonas Santol, David Pereyra, Yawen Dong, Heidi M. Connolly, Patricia A. Pellikka, Hartzell V. Schaff, Juan A. Crestanello, Cornelius A. Thiels, Susanne G. Warner, Mark J. Truty, Michael L. Kendrick, Rory L. Smoot, Thorvardur R. Halfdanarson, David M. Nagorney, Patrick P. StarlingerAbstract
Carcinoid heart disease (CHD) is associated with advanced neuroendocrine tumor liver metastases (NETLM) and may preclude surgical cytoreduction. We assessed perioperative and long‐term outcomes of hepatectomy in patients with CHD. We retrospectively analyzed 311 patients undergoing cytoreductive hepatectomy for intestinal NETLM: non‐functional ( n = 163), carcinoid syndrome (CS) without CHD ( n = 110), and CHD ( n = 38), including patients undergoing pre‐hepatectomy valve replacement. CHD patients more frequently had >10 liver metastases (78%) and larger lesions (median 9.5 cm) and required major hepatectomy more often (58%). Major morbidity was higher in CHD (up to 47%), yet 90‐day mortality remained low (≤4%). Median overall survival after hepatectomy was comparable across groups (12.5 vs. 9.1 vs. 11.4 years; p = .19), including matched analyses. With optimal cardiac management, cytoreductive hepatectomy in CHD is feasible and provides long‐term survival comparable to patients without CHD.