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

Amelia C. Grover, Steven K. Libutti, James F. Pingpank, Cynthia Helsabeck, Tatiana Beresnev, H. Richard Alexander

Research output: Contribution to journalArticle

26 Citations (Scopus)

Abstract

We report results of using isolated hepatic perfusion (IHP) in patients with advanced progressive liver metastases (LM) from pancreatic and gastrointestinal neuroendocrine neoplasms (NENs). 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. 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). For patients with advanced LM from NENs, IHP provides a reasonable response rate and duration with acceptable morbidity; continued clinical evaluation is important.

Original languageEnglish (US)
Pages (from-to)1176-1182
Number of pages7
JournalSurgery
Volume136
Issue number6
DOIs
StatePublished - Dec 2004
Externally publishedYes

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Gastrointestinal Neoplasms
Perfusion
Neoplasm Metastasis
Liver
Inferior Vena Cava
Therapeutics
Axillary Vein
Melphalan
Survival
Hepatic Artery
Liver Neoplasms
Operative Time
Laparotomy
Disease-Free Survival
Length of Stay
Arteries
Tumor Necrosis Factor-alpha
Morbidity
Recurrence
Mortality

ASJC Scopus subject areas

  • Surgery

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Isolated hepatic perfusion for the treatment of patients with advanced liver metastases from pancreatic and gastrointestinal neuroendocrine neoplasms. / Grover, Amelia C.; Libutti, Steven K.; Pingpank, James F.; Helsabeck, Cynthia; Beresnev, Tatiana; Alexander, H. Richard.

In: Surgery, Vol. 136, No. 6, 12.2004, p. 1176-1182.

Research output: Contribution to journalArticle

Grover, Amelia C. ; Libutti, Steven K. ; Pingpank, James F. ; Helsabeck, Cynthia ; Beresnev, Tatiana ; Alexander, H. Richard. / Isolated hepatic perfusion for the treatment of patients with advanced liver metastases from pancreatic and gastrointestinal neuroendocrine neoplasms. In: Surgery. 2004 ; Vol. 136, No. 6. pp. 1176-1182.
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