Metastatic carcinoid to the liver treated by hepatic dearterialization

A historical review of work bearing on the rationale for hepatic artery ligation in the treatment of malignant disease in the liver is presented, particularly the early work showing that malignant disease of the liver is supplied primarily by the arterial circulation and not by the portal. A review is presented of some clinical reports dealing with the effectiveness of this approach and our own limited experience with three cases presented briefly. The major emphasis is placed on the metabolic, arteriographic, microscopic and clinical studies on one patient with the carcinoid syndrome who was followed carefully over several years, treated initially by hepatic resection, later by chemotherapy and finally by hepatic dearterialization as the tumor re-grew and the carcinoid syndrome again became incapacitating. Clinical remissions was documented by changes in the excretion of 5-hydroxyindole- acetic acid and by comparison between pre- and post-op arteriography and by microscopic sections taken at re-exploration for drainage of a necrotic area in the liver.