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Isolated hepatic perfusion for the treatment of patients with advanced liver metastases from pancreatic and gastrointestinal neuroendocrine neoplasms. | LitMetric

AI Article Synopsis

  • This study evaluates isolated hepatic perfusion (IHP) for patients with advanced liver metastases from neuroendocrine neoplasms (NENs), treating 13 patients with a combination of melphalan and tumor necrosis factor.
  • After the treatment, 50% of patients showed a significant reduction in liver metastases, lasting an average of 15 months, while others had varying responses.
  • The findings suggest that IHP can be an effective treatment option for liver metastases from NENs, with manageable side effects, but further research is needed to confirm these results.

Article Abstract

Background: We report results of using isolated hepatic perfusion (IHP) in patients with advanced progressive liver metastases (LM) from pancreatic and gastrointestinal neuroendocrine neoplasms (NENs).

Methods: Thirteen patients with LM from NENs (mean percent hepatic replacement, 30; range, 10-60) were treated with a 1-hour hyperthermic IHP via a laparotomy with the use of 1.5 or 2.0 mg/kg melphalan and/or 1 mg tumor necrosis factor. An oxygenated extracorporeal circuit with inflow through the gastroduodenal artery and common hepatic artery, and outflow to a segment of the inferior vena cava was used. Portal flow and inferior vena cava flow were shunted to the axillary vein. Radiographic response, recurrence pattern, and survival were assessed.

Results: Mean operative time was 9 hours (8-11 hours), and a median hospital stay was 10 days (6-64 days). Fifty percent of evaluable patients had a radiographic partial response in the liver (mean duration, 15 months; range, 6-26 months; 2 ongoing). Four had a marginal response (25%-49% reduction in the neoplasm). The median, hepatic, progression-free survival was 7 months (range, 3-27 months). The median actuarial survival was 48 months including 1 treatment mortality (median follow-up, 23 months).

Conclusions: For patients with advanced LM from NENs, IHP provides a reasonable response rate and duration with acceptable morbidity; continued clinical evaluation is important.

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Source
http://dx.doi.org/10.1016/j.surg.2004.06.044DOI Listing

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