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Periprocedural Management of Patients Undergoing Liver Resection or Embolotherapy for Neuroendocrine Tumor Metastases

Kwon, Daniel H., MD*†; Paciorek, Alan, BS†‡; Mulvey, Claire K., MD*†; Chan, Hilary, BA*†; Fidelman, Nicholas, MD†§; Meng, Lingzhong, MD; Nakakura, Eric K., MD, PhD†¶; Zhang, Li, PhD*†‡; Bergsland, Emily K., MD*†; Van Loon, Katherine, MD, MPH*†

doi: 10.1097/MPA.0000000000001271
Original Articles

Objectives The objective of this study was to describe the periprocedural management of patients with well-differentiated neuroendocrine tumors with hepatic metastases who underwent liver-directed procedures.

Methods We performed a retrospective review of patients with metastatic neuroendocrine tumors who underwent liver resection, ablation, or embolotherapy at a single center from 2012 to 2016. The primary outcome was occurrence of documented carcinoid crisis (CC) or hemodynamic instability (HDI), defined as 10 minutes or more of systolic blood pressure less than 80 or greater than 180 mm Hg, or pulse greater than 120 beats per minute.

Results We identified 75 patients who underwent liver resection/ablation (n = 38) or embolotherapy (n = 37). Twenty-four patients (32%) experienced CC or HDI (CC/HDI); CC occurred in 3 patients. No clinicopathologic or procedural factors, including procedure type, octreotide or long-acting somatostatin analog use, and history of carcinoid syndrome, were associated with CC/HDI. Grades 2 to 4 complications were reported in 42% of patients who experienced CC/HDI versus in 16% of patients who did not experience CC/HDI (P < 0.05).

Conclusions A significant portion of patients developed CC/HDI, and these patients were more likely to develop severe postprocedural complications. Periprocedural octreotide use was not associated with lower CC/HDI occurrence, but continued use is advised given its safety profile until additional studies definitively demonstrate lack of benefit.

From the *Division of Hematology and Oncology, Department of Medicine,

Helen Diller Family Comprehensive Cancer Center, Departments of

Epidemiology and Biostatistics and

§Radiology, University of California, San Francisco, San Francisco, CA;

Department of Anesthesiology, Yale University, New Haven, CT; and

Department of Surgery, University of California, San Francisco, San Francisco, CA.

Received for publication May 1, 2018; accepted February 15, 2019.

Address correspondence to: Katherine Van Loon, MD, MPH, Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, 550 16th St, Box 3211, San Francisco, CA 94143 (e-mail:

The authors declare no conflict of interest.

Presented at the 2017 North American Neuroendocrine Tumor Society Symposium, October 20, 2017, Philadelphia, PA (abstract 291).

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