Skip to main content
PMC home page
Annals of Surgery logoLink to Annals of Surgery
. 1997 Apr;225(4):347–354. doi: 10.1097/00000658-199704000-00002

Liver transplantation for metastatic neuroendocrine tumors.

H Lang 1, K J Oldhafer 1, A Weimann 1, H J Schlitt 1, G F Scheumann 1, P Flemming 1, B Ringe 1, R Pichlmayr 1
PMCID: PMC1190741  PMID: 9114792

Abstract

OBJECTIVE: This article describes the experience with liver transplantation in patients with irresectable neuroendocrine hepatic metastases. SUMMARY BACKGROUND DATA: Liver transplantation has become an established therapy in primary liver cancer. On contrast, there is little experience with liver transplantation in secondary hepatic tumors. So far, in the majority of patients being transplanted for irresectable liver metastases, long-term results have been disappointing because of early tumor recurrence. Because of their biologically less aggressive nature, the metastases of neuroendocrine tumors could represent a justified indication for liver grafting. METHODS: In a retrospective study, the data of 12 patients who underwent liver transplantation for irresectable neuroendocrine hepatic metastases were analyzed regarding survival, tumor recurrence, and symptomatic relief. RESULTS: Nine of 12 patients currently are alive with a median survival of 55 months (range, 11.0 days to 103.5 months). The operative mortality was 1 of 12, 2 patients died because of septic complications or tumor recurrences or both 6.5 months and 68.0 months after transplantation. all patients had good symptomatic relief after hepatectomy and transplantation. Four of the nine patients who are alive have no evidence of tumor with a follow-up of 2.0, 57.0, 58.0, and 103.5 months after transplantation. CONCLUSIONS: In selected patients, liver transplantation for irresectable neuroendocrine hepatic metastases may provide not only long-term palliation but even cure. Regarding the shortage of donor organs, liver grafting for neuroendocrine metastases should be considered solely in patients without evidence of extrahepatic tumor manifestation and in whom all other treatment methods are no longer effective.

Full text

PDF
347

Images in this article

349Figure 1.
on p.349
350Figure 3.
on p.350

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Ahlman H., Westberg G., Wängberg B., Nilsson O., Tylén U., Scherstén T., Tisell L. E. Treatment of liver metastases of carcinoid tumors. World J Surg. 1996 Feb;20(2):196–202. doi: 10.1007/s002689900030. [DOI] [PubMed] [Google Scholar]
  2. Alessiani M., Tzakis A., Todo S., Demetris A. J., Fung J. J., Starzl T. E. Assessment of five-year experience with abdominal organ cluster transplantation. J Am Coll Surg. 1995 Jan;180(1):1–9. [PMC free article] [PubMed] [Google Scholar]
  3. Alsina A. E., Bartus S., Hull D., Rosson R., Schweizer R. T. Liver transplant for metastatic neuroendocrine tumor. J Clin Gastroenterol. 1990 Oct;12(5):533–537. doi: 10.1097/00004836-199010000-00009. [DOI] [PubMed] [Google Scholar]
  4. Anthuber M., Jauch K. W., Briegel J., Groh J., Schildberg F. W. Results of liver transplantation for gastroenteropancreatic tumor metastases. World J Surg. 1996 Jan;20(1):73–76. doi: 10.1007/s002689900013. [DOI] [PubMed] [Google Scholar]
  5. Arnold J. C., O'Grady J. G., Bird G. L., Calne R. Y., Williams R. Liver transplantation for primary and secondary hepatic apudomas. Br J Surg. 1989 Mar;76(3):248–249. doi: 10.1002/bjs.1800760311. [DOI] [PubMed] [Google Scholar]
  6. Arnold R. Medical treatment of metastasizing carcinoid tumors. World J Surg. 1996 Feb;20(2):203–207. doi: 10.1007/s002689900031. [DOI] [PubMed] [Google Scholar]
  7. Bechstein W. O., Neuhaus P. Liver transplantation for hepatic metastases of neuroendocrine tumors. Ann N Y Acad Sci. 1994 Sep 15;733:507–514. doi: 10.1111/j.1749-6632.1994.tb17301.x. [DOI] [PubMed] [Google Scholar]
  8. Delcore R., Friesen S. R. Gastrointestinal neuroendocrine tumors. J Am Coll Surg. 1994 Feb;178(2):187–211. [PubMed] [Google Scholar]
  9. Farmer D. G., Shaked A., Colonna J. O., 2nd, Olthoff K. M., Jurim O., Colquhoun S., Millis J. M., Busuttil R. W. Radical resection combined with liver transplantation for foregut tumors. Am Surg. 1993 Dec;59(12):806–812. [PubMed] [Google Scholar]
  10. Gulanikar A. C., Kotylak G., Bitter-Suermann H. Does immunosuppression alter the growth of metastatic liver carcinoid after orthotopic liver transplantation? Transplant Proc. 1991 Aug;23(4):2197–2198. [PubMed] [Google Scholar]
  11. Hajarizadeh H., Ivancev K., Mueller C. R., Fletcher W. S., Woltering E. A. Effective palliative treatment of metastatic carcinoid tumors with intra-arterial chemotherapy/chemoembolization combined with octreotide acetate. Am J Surg. 1992 May;163(5):479–483. doi: 10.1016/0002-9610(92)90392-5. [DOI] [PubMed] [Google Scholar]
  12. Knechtle S. J., Kalayoglu M., D'Alessandro A. M., Pirsch J. D., Hoffmann R. M., Sollinger H. W., Belzer F. O. Should abdominal cluster transplantation be abandoned? Transplant Proc. 1993 Feb;25(1 Pt 2):1361–1363. [PubMed] [Google Scholar]
  13. Kvols L. K., Buck M. Chemotherapy of metastatic carcinoid and islet cell tumors. A review. Am J Med. 1987 May 29;82(5B):77–83. doi: 10.1016/0002-9343(87)90430-x. [DOI] [PubMed] [Google Scholar]
  14. Kvols L. K., Moertel C. G., O'Connell M. J., Schutt A. J., Rubin J., Hahn R. G. Treatment of the malignant carcinoid syndrome. Evaluation of a long-acting somatostatin analogue. N Engl J Med. 1986 Sep 11;315(11):663–666. doi: 10.1056/NEJM198609113151102. [DOI] [PubMed] [Google Scholar]
  15. Makowka L., Tzakis A. G., Mazzaferro V., Teperman L., Demetris A. J., Iwatsuki S., Starzl T. E. Transplantation of the liver for metastatic endocrine tumors of the intestine and pancreas. Surg Gynecol Obstet. 1989 Feb;168(2):107–111. [PMC free article] [PubMed] [Google Scholar]
  16. Margreiter R., Niederwieser D., Frommhold H., Schönitzer D., Gratwohl A., Huber C. Tumor recurrence after liver transplantation followed by high-dose cyclophosphamide, total body irradiation, and autologous bone marrow transplantation for treatment of metastatic liver disease. Transplant Proc. 1987 Feb;19(1 Pt 3):2403–2404. [PubMed] [Google Scholar]
  17. Martin J. K., Jr, Moertel C. G., Adson M. A., Schutt A. J. Surgical treatment of functioning metastatic carcinoid tumors. Arch Surg. 1983 May;118(5):537–542. doi: 10.1001/archsurg.1983.01390050021004. [DOI] [PubMed] [Google Scholar]
  18. McEntee G. P., Nagorney D. M., Kvols L. K., Moertel C. G., Grant C. S. Cytoreductive hepatic surgery for neuroendocrine tumors. Surgery. 1990 Dec;108(6):1091–1096. [PubMed] [Google Scholar]
  19. Moertel C. G., Johnson C. M., McKusick M. A., Martin J. K., Jr, Nagorney D. M., Kvols L. K., Rubin J., Kunselman S. The management of patients with advanced carcinoid tumors and islet cell carcinomas. Ann Intern Med. 1994 Feb 15;120(4):302–309. doi: 10.7326/0003-4819-120-4-199402150-00008. [DOI] [PubMed] [Google Scholar]
  20. Moertel C. G. Karnofsky memorial lecture. An odyssey in the land of small tumors. J Clin Oncol. 1987 Oct;5(10):1502–1522. doi: 10.1200/JCO.1987.5.10.1502. [DOI] [PubMed] [Google Scholar]
  21. Moertel C. G., Lefkopoulo M., Lipsitz S., Hahn R. G., Klaassen D. Streptozocin-doxorubicin, streptozocin-fluorouracil or chlorozotocin in the treatment of advanced islet-cell carcinoma. N Engl J Med. 1992 Feb 20;326(8):519–523. doi: 10.1056/NEJM199202203260804. [DOI] [PubMed] [Google Scholar]
  22. O'Grady J. G., Polson R. J., Rolles K., Calne R. Y., Williams R. Liver transplantation for malignant disease. Results in 93 consecutive patients. Ann Surg. 1988 Apr;207(4):373–379. doi: 10.1097/00000658-198804000-00002. [DOI] [PMC free article] [PubMed] [Google Scholar]
  23. Olthoff K. M., Millis J. M., Rosove M. H., Goldstein L. I., Ramming K. P., Busuttil R. W. Is liver transplantation justified for the treatment of hepatic malignancies? Arch Surg. 1990 Oct;125(10):1261–1268. doi: 10.1001/archsurg.1990.01410220045007. [DOI] [PubMed] [Google Scholar]
  24. Penn I. Hepatic transplantation for primary and metastatic cancers of the liver. Surgery. 1991 Oct;110(4):726–735. [PubMed] [Google Scholar]
  25. Perry L. J., Stuart K., Stokes K. R., Clouse M. E. Hepatic arterial chemoembolization for metastatic neuroendocrine tumors. Surgery. 1994 Dec;116(6):1111–1117. [PubMed] [Google Scholar]
  26. Pichlmayr R., Weimann A., Oldhafer K. J., Schlitt H. J., Klempnauer J., Bornscheuer A., Chavan A., Schmoll E., Lang H., Tusch G. Role of liver transplantation in the treatment of unresectable liver cancer. World J Surg. 1995 Nov-Dec;19(6):807–813. doi: 10.1007/BF00299775. [DOI] [PubMed] [Google Scholar]
  27. Pichlmayr R., Weimann A., Ringe B. Indications for liver transplantation in hepatobiliary malignancy. Hepatology. 1994 Jul;20(1 Pt 2):33S–40S. doi: 10.1016/0270-9139(94)90271-2. [DOI] [PubMed] [Google Scholar]
  28. Que F. G., Nagorney D. M., Batts K. P., Linz L. J., Kvols L. K. Hepatic resection for metastatic neuroendocrine carcinomas. Am J Surg. 1995 Jan;169(1):36–43. doi: 10.1016/s0002-9610(99)80107-x. [DOI] [PubMed] [Google Scholar]
  29. Ringe B., Wittekind C., Bechstein W. O., Bunzendahl H., Pichlmayr R. The role of liver transplantation in hepatobiliary malignancy. A retrospective analysis of 95 patients with particular regard to tumor stage and recurrence. Ann Surg. 1989 Jan;209(1):88–98. doi: 10.1097/00000658-198901000-00013. [DOI] [PMC free article] [PubMed] [Google Scholar]
  30. Ringe B., Wittekind C., Weimann A., Tusch G., Pichlmayr R. Results of hepatic resection and transplantation for fibrolamellar carcinoma. Surg Gynecol Obstet. 1992 Oct;175(4):299–305. [PubMed] [Google Scholar]
  31. Starzl T. E., Todo S., Tzakis A., Podesta L., Mieles L., Demetris A., Teperman L., Selby R., Stevenson W., Stieber A. Abdominal organ cluster transplantation for the treatment of upper abdominal malignancies. Ann Surg. 1989 Sep;210(3):374–386. doi: 10.1097/00000658-198909000-00013. [DOI] [PMC free article] [PubMed] [Google Scholar]
  32. Søreide O., Berstad T., Bakka A., Schrumpf E., Hanssen L. E., Engh V., Bergan A., Flatmark A. Surgical treatment as a principle in patients with advanced abdominal carcinoid tumors. Surgery. 1992 Jan;111(1):48–54. [PubMed] [Google Scholar]
  33. Wenisch H. J., Markus B. H., Herrmann G. H., Usadel K. H., Encke A. Multiviscerale Oberbauchresektion und orthotope Lebertransplantation--ein chirurgisches Behandlungskonzept für regionär metastasierende Tumoren des endocrinen Pancreas. Zentralbl Chir. 1992;117(6):334–342. [PubMed] [Google Scholar]

Articles from Annals of Surgery are provided here courtesy of Lippincott, Williams, and Wilkins

RESOURCES