Surgery versus intra-arterial therapy for neuroendocrine liver metastasis: A multicenter international analysis

Skye C. Mayo, Mechteld C. De Jong, Mark Bloomston, Carlo Pulitano, Bryan M. Clary, Srinevas K. Reddy, T. Clark Gamblin, Scott A. Celinski, David A. Kooby, Charles A. Staley, Jayme B. Stokes, Carrie K. Chu, David Arrese, Alessandro Ferrero, Richard D. Schulick, Michael A. Choti, Jean Francois H. Geschwind, Jennifer Strub, Todd W. Bauer, Reid B. AdamsLuca Aldrighetti, Gilles Mentha, Lorenzo Capussotti, Timothy M. Pawlik

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98 Scopus citations

Abstract

Background: Management of patients with neuroendocrine liver metastasis (NELM) remains controversial. We sought to examine the relative efficacy of surgical management versus intra-arterial therapy (IAT) for NELM and determine factors predictive of survival. Methods: A total of 753 patients who had surgery (n = 339) or IAT (n = 414) for NELM from 1985 to 2010 were identified from nine hepatobiliary centers. Clinicopathologic data were assessed with regression modeling and propensity score matching. Results: Most patients had a pancreatic (32%) or a small bowel (27%) primary tumor; 47% had a hormonally active tumor. There were statistically significant differences in characteristics between surgery versus IAT groups (hormonally active tumors: 28 vs. 48%; hepatic tumor burden >25%: 52% vs. 76%) (all P < 0.001). Among surgical patients, most underwent hepatic resection alone without ablation (78%). The median number of IAT treatments was 1 (range, 1-4). Median and 5-year survival of patients treated with surgery was 123 months and 74% vs. 34 months and 30% for IAT (P < 0.001). In the propensity-adjusted multivariate Cox model, asymptomatic disease (hazard ratio 2.6) was strongly associated with worse outcome (P = 0.001). Although surgical management provided a survival benefit over IAT among symptomatic patients with >25% hepatic tumor involvement, there was no difference in long-term outcome after surgery versus IAT among asymptomatic patients (P = 0.78). Conclusions: Asymptomatic patients with a large (>25%) burden of liver disease benefited least from surgical management and IAT may be a more appropriate treatment strategy. Surgical management of NELM should be reserved for patients with low-volume disease or for those patients with symptomatic high-volume disease.

Original languageEnglish (US)
Pages (from-to)3657-3665
Number of pages9
JournalAnnals of surgical oncology
Volume18
Issue number13
DOIs
StatePublished - Dec 1 2011

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ASJC Scopus subject areas

  • Surgery
  • Oncology

Cite this

Mayo, S. C., De Jong, M. C., Bloomston, M., Pulitano, C., Clary, B. M., Reddy, S. K., Clark Gamblin, T., Celinski, S. A., Kooby, D. A., Staley, C. A., Stokes, J. B., Chu, C. K., Arrese, D., Ferrero, A., Schulick, R. D., Choti, M. A., Geschwind, J. F. H., Strub, J., Bauer, T. W., ... Pawlik, T. M. (2011). Surgery versus intra-arterial therapy for neuroendocrine liver metastasis: A multicenter international analysis. Annals of surgical oncology, 18(13), 3657-3665. https://doi.org/10.1245/s10434-011-1832-y