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Published on: March 10, 2023
Role of hepatic resection for patients with carcinoid heart disease
Alain M Bernheim1, Heidi M Connolly, Joseph Rubin
1Division of Cardiovascular Diseases, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA.
Insights
Resecting hepatic carcinoid metastases significantly improves survival and reduces cardiac progression in patients with carcinoid heart disease. Eligible patients should be considered for this surgery.
Area of Science:
- Cardiology
- Surgical Oncology
- Gastroenterology
Background:
- Carcinoid heart disease (CHD) is a complication of neuroendocrine tumors, often involving cardiac valve dysfunction.
- Hepatic metastases are common in carcinoid syndrome and contribute to disease progression.
- Surgical intervention for hepatic metastases in CHD is debated.
Purpose of the Study:
- To evaluate the impact of hepatic resection of carcinoid metastases on the progression and prognosis of carcinoid heart disease.
- To determine if surgical removal of liver tumors affects cardiac outcomes in CHD patients.
Main Methods:
- Retrospective analysis of 265 patients with CHD from 1980-2005.
- Hepatic resection data was analyzed as a time-dependent covariate.
- Cardiac progression was assessed using serial echocardiograms and a validated cardiac severity score.
Main Results:
- Hepatic resection was performed in 12% of patients, showing significantly higher 5-year survival (86.5%) compared to non-resected patients (29.0%).
- Multivariable analysis confirmed hepatic resection was strongly associated with improved prognosis (HR 0.31, P=.003).
- Resection was independently associated with a decreased risk of cardiac progression (OR 0.29, P=.03).
Conclusions:
- Hepatic resection in patients with carcinoid heart disease is associated with reduced cardiac progression.
- Improved prognosis and survival are observed in patients undergoing hepatic resection for carcinoid metastases.
- Consideration for hepatic surgery is recommended for eligible patients with carcinoid heart disease and liver metastases.
Objective:
To evaluate the effects of resection of hepatic carcinoid metastases on progression and prognosis of carcinoid heart disease.
Patients And Methods:
From our database of 265 consecutive patients diagnosed as having carcinoid heart disease from January 1, 1980, through December 31, 2005, we calculated survival from first diagnosis of cardiac involvement. Hepatic resection during follow-up was entered as a time-dependent covariable in a multivariable analysis. In patients with serial echocardiograms more than 1 year apart without intervening cardiac surgery, a previously validated cardiac severity score was calculated. A score increase that exceeded 25% was considered relevant progression.
Results:
Hepatic resection was performed in 31 patients (12%) during follow-up. Five-year survival was significantly higher in these patients (86.5%; 95% confidence interval [CI], 73.5%-100.0%) than in patients without hepatic resection (29.0%; 95% CI, 23.3%-36.1%; univariable hazard ratio for hepatic resection, 0.25; 95% CI 0.12-0.53; P<.001). Hepatic resection remained strongly associated with improved prognosis in multivariable analysis (hazard ratio, 0.31; 95% CI, 0.14-0.66; P=.003). Among 77 patients (29%) with serial echocardiograms, 10 (13%) underwent hepatic resection during follow-up; resection was independently associated with decreased risk of cardiac progression (odds ratio, 0.29; 95% CI, 0.06-0.75; P=.03).
Conclusion:
Despite the limitations of this retrospective nonrandomized study, our data suggest that patients with carcinoid heart disease who undergo hepatic resection have decreased cardiac progression and improved prognosis. Eligible patients should be considered for hepatic surgery.