Clinical

Hepatic resection slows progression of carcinoid heart disease

Last Updated: 2008-02-29 14:50:36 -0400 (Reuters Health)

NEW YORK (Reuters Health) - Resection of hepatic carcinoid metastases reduces cardiac progression and improves prognosis, according to a report in the February Mayo Clinic Proceedings.

Carcinoid heart disease is associated with liver metastases that permit large quantities of vasoactive substances to reach the right side of the heart without being inactivated by first-pass liver metabolism, the authors explain.

Dr. Alain M. Bernheim and colleagues from the Mayo Clinic in Rochester, Minnesota analyzed the effect of hepatic resection on progression of cardiac lesions and prognosis in 77 patients with carcinoid heart disease who had serial echocardiograms done at least one year apart. Ten patients had resections during the observation period.

Progression of cardiac lesions was seen in 1 of the 10 patients who underwent hepatic resection during follow-up, the authors report, compared with 42 of 67 patients (63%) who did not undergo hepatic resection during that period.

Patients who had no resection had a significantly greater increase in echocardiographic score and significantly higher 5-HIAA levels than did patients who underwent hepatic resection.

Five-year survival after carcinoid heart disease diagnosis was significantly greater in patients who had hepatic resection (86.5%, vs 29.0% in patients without hepatic resection), the report indicates.

On multivariate analysis, hepatic resection performed during follow-up was independently associated with improved survival and with a decreased risk of progression of cardiac lesions.

The authors believe that the better outcomes after liver resection are related at least in part to decreased progression of cardiac lesions.

"Our findings suggest that, in patients with carcinoid heart disease who are eligible for hepatic resection, surgical debulking of the tumor burden in the liver can improve survival," the authors conclude.

They advise, "Eligible patients with metastatic carcinoid tumors and carcinoid heart disease should be considered for hepatic surgery before their tumors have reached an inoperable state."

Mayo Clin Proc 2008;83:143-150.