TY - JOUR
T1 - Surgical management of hepatic neuroendocrine tumor metastasis
T2 - Results from an international multi-institutional analysis
AU - Mayo, Skye C.
AU - De Jong, Mechteld C.
AU - Pulitano, Carlo
AU - Clary, Brian M.
AU - Reddy, Srinevas K.
AU - Gamblin, T. Clark
AU - Celinksi, Scott A.
AU - Kooby, David A.
AU - Staley, Charles A.
AU - Stokes, Jayme B.
AU - Chu, Carrie K.
AU - Ferrero, Alessandro
AU - Schulick, Richard D.
AU - Choti, Michael A.
AU - Mentha, Giles
AU - Strub, Jennifer
AU - Bauer, Todd W.
AU - Adams, Reid B.
AU - Aldrighetti, Luca
AU - Capussotti, Lorenzo
AU - Pawlik, Timothy M.
PY - 2010/12
Y1 - 2010/12
N2 - Background: Management of neuroendocrine tumor liver metastasis (NELM) remains controversial, with some advocating an aggressive surgical approach while others have adopted a more conservative strategy. We sought to define the efficacy of the surgical management of NELM in a large multicenter international cohort of patients. Methods: We identified 339 patients who underwent surgical management for NELM from 1985 to 2009 from an international database of eight major hepatobiliary centers. Relevant clinicopathologic data were assessed using Kaplan-Meier and Cox regression models. Results: Most patients had a pancreatic (40%) or small bowel (25%) neuroendocrine tumor (NET) primary. The majority of patients (60%) had bilateral liver disease. At surgery, 78% of patients underwent hepatic resection, 3% ablation alone, and 19% resection + ablation. Major hepatectomy was performed in 45% of patients, and 14% underwent a second liver operation. Carcinoid was the most common NET histological subtype (53%). Median survival was 125 months, with overall 5- and 10-year survival of 74%, and 51%, respectively. Disease recurred in 94% of patients at 5 years. Patients with hormonally functional NET who had R0/R1 resection benefited the most from surgery (P = 0.01). On multivariate analyses, synchronous disease [hazard ratio (HR) = 1.9], nonfunctional NET hormonal status (HR = 2.0), and extrahepatic disease (HR = 3.0) remained predictive of worse survival (all P < 0.05). Conclusions: Liver-directed surgery for NELM is associated with prolonged survival; however, the majority of patients will develop recurrent disease. Patients with hormonally functional hepatic metastasis without prior extrahepatic or synchronous disease derive the greatest survival benefit from surgical management.
AB - Background: Management of neuroendocrine tumor liver metastasis (NELM) remains controversial, with some advocating an aggressive surgical approach while others have adopted a more conservative strategy. We sought to define the efficacy of the surgical management of NELM in a large multicenter international cohort of patients. Methods: We identified 339 patients who underwent surgical management for NELM from 1985 to 2009 from an international database of eight major hepatobiliary centers. Relevant clinicopathologic data were assessed using Kaplan-Meier and Cox regression models. Results: Most patients had a pancreatic (40%) or small bowel (25%) neuroendocrine tumor (NET) primary. The majority of patients (60%) had bilateral liver disease. At surgery, 78% of patients underwent hepatic resection, 3% ablation alone, and 19% resection + ablation. Major hepatectomy was performed in 45% of patients, and 14% underwent a second liver operation. Carcinoid was the most common NET histological subtype (53%). Median survival was 125 months, with overall 5- and 10-year survival of 74%, and 51%, respectively. Disease recurred in 94% of patients at 5 years. Patients with hormonally functional NET who had R0/R1 resection benefited the most from surgery (P = 0.01). On multivariate analyses, synchronous disease [hazard ratio (HR) = 1.9], nonfunctional NET hormonal status (HR = 2.0), and extrahepatic disease (HR = 3.0) remained predictive of worse survival (all P < 0.05). Conclusions: Liver-directed surgery for NELM is associated with prolonged survival; however, the majority of patients will develop recurrent disease. Patients with hormonally functional hepatic metastasis without prior extrahepatic or synchronous disease derive the greatest survival benefit from surgical management.
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U2 - 10.1245/s10434-010-1154-5
DO - 10.1245/s10434-010-1154-5
M3 - Article
C2 - 20585879
AN - SCOPUS:78650980295
SN - 1068-9265
VL - 17
SP - 3129
EP - 3136
JO - Annals of surgical oncology
JF - Annals of surgical oncology
IS - 12
ER -