An operation which removes the tumor entirely is the first and foremost treatment both for carcinoid tumors as well as neuroendocrine tumors of the pancreas (islet cell tumors). Small (<1-2 cm in diameter), well-differentiated carcinoids of the stomach, duodenum or the rectum can usually be removed without abdominal surgery. These small, well-differentiated (G1) carcinoids of the stomach, duodenum or rectum can be removed endoscopically, i.e. under short-term anesthesia as part of an esophagogastroduodenoscopy or colonoscopy.
Removing a great deal of the tumor load of metastatic, well-differentiated, neuroendocrine tumor disease makes sense even if not all of the tumor metastases but at least the majority (>80%) of the tumor masses can be resected surgically. Surgery is also indicated in case of intestinal stenosis or gastrointestinal bleeding, or if intestinal blood flow is restricted by the desmoplastic fibrosis of a midgut carcinoid. Removing the primary tumor and eliminating or destroying (a major portion of) the metastases reduces the amount of damaging hormones circulating in the blood. In many patients, this leads to a long-lasting alleviation of the symptoms.

Treating liver metastases

If carcinoids or islet cell tumors spread to distant organs ("advanced tumor disease") it is usually the liver which is affected. If the metastases are limited to the liver, eliminating or destroying the liver metastases is the aim once the primary tumor has been resected surgically. Methods for treating neuroendocrine liver metastases include:

• Surgery (removal of the liver metastases)
• Radiofrequency-induced thermoablation (RITA) or laser-induced (LITT) thermotherapy
• Percutaneous ethanol or acetic acid injection (PEI)
• Transarterial (chemo-) embolization (TACE or TAE)
• Transarterial radioembolisation (TARE) or selective internal radiotherapy (SIRT)
• Peptide receptor radionuclide therapy (PRRT)
• Medical drug therapy

or a combination of various treatment modalities (multimodal therapy).

Surgery / partial resection of the liver

Well differentiated neuroendocrine liver metastases should be surgically resected if possible. Thereby the surgeon removes the liver segment(s) that harbor(s) the metastases or he enucleates the metastasis. Since well-differentiated (G1) neuroendocrine liver metastases do not compromise liver function, liver failure is very uncommon with well-differentiated neuroendocrine liver metastases.
It should be noted that liver transplantation has successful been performed in patients with well-differentiated liver metastases of intestinal carcinoids. However, liver transplantation has not become a clinical standard, since the observed 5-year-survival rate was not significantly better than the 5-year-survival rate of patients whose neuroendocrine liver metastases were treated without liver transplantation.

Figure 10: Diagram of the liver segments I-VIII



Modified according to Steinberg & Scherübl, Patient Brochure Falkfoundation 2008

Contact

Center of Neuroendocrine Tumors
Prof. Dr. med. Hans Scherübl
Vivantes Klinikum Am Urban
Academic Teaching Hospital of Charité-University Medicine, Berlin
Dieffenbachstraße 1
10967 Berlin, Germany
Tel: + 49 30 130 225201
Fax: + 49 30 130 225205
Email: This email address is being protected from spambots. You need JavaScript enabled to view it.
vivantes.de/kau/gastro/