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Surgery Provides Long-Term Survival in Patients with Metastatic Neuroendocrine Tumors Undergoing Resection for Non-Hormonal Symptoms

  • 2018 SSAT Plenary Presentation
  • Published:
Journal of Gastrointestinal Surgery Aims and scope

Abstract

Introduction

Patients with metastatic neuroendocrine tumor (NET) often have an indolent disease course yet the outcomes for patients with metastatic NET undergoing surgery for non-hormonal (NH) symptoms of GI obstruction, bleeding, or pain is not known.

Methods

We identified patients with metastatic gastroenteropancreatic NET who underwent resection from 2000 to 2016 at 8 academic institutions who participated in the US Neuroendocrine Tumor Study Group.

Results

Of 581 patients with metastatic NET to liver (61.3%), lymph nodes (24.1%), lung (2.1%), and bone (2.5%), 332 (57.1%) presented with NH symptoms of pain (n = 223, 67.4%), GI bleeding (n = 54, 16.3%), GI obstruction (n = 49, 14.8%), and biliary obstruction (n = 22, 6.7%). Most patients were undergoing their first operation (85.4%) within 4 weeks of diagnosis. The median overall survival was 110.4 months, and operative intent predicted survival (p < 0.001) with 66.3% undergoing curative resection. Removal of all metastatic disease was associated with the longest median survival (112.5 months) compared to debulking (89.2 months), or palliative resection (50.0 months; p < 0.001). The 1-, 3-, and 12-month mortality was 3.0%, 4.5%, and 9.0%, respectively. Factors associated with 1-year mortality included palliative operations (OR 6.54, p = 0.006), foregut NET (5.62, p = 0.042), major complication (4.91, p = 0.001), and high tumor grade (11.2, p < 0.001). The conditional survival for patients who lived past 1 year was 119 months.

Conclusions

Patients with metastatic NET and NH symptoms that necessitate surgery have long-term survival, and goals of care should focus on both oncologic and quality of life impact. Surgical intervention remains a critical component of multidisciplinary care of symptomatic patients.

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Author information

Authors and Affiliations

  1. Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, 320 W 10th Ave, M256 Starling Loving Hall, Columbus, OH, 43210-1267, USA

    Jeffery Chakedis, Eliza W. Beal, Timothy M. Pawlik, Carl R. Schmidt & Mary Dillhoff

  2. Division of Surgical Oncology, Department of Surgery, Emory University, Winship Cancer Institute, Atlanta, GA, USA

    Alexandra G. Lopez-Aguiar & Shishir K Maithel

  3. Department of Surgery, Stanford University, Palo Alto, CA, USA

    George Poultsides & Eleftherios Makris

  4. Department of Surgery, Virginia Mason Medical Center, Seattle, WA, USA

    Flavio G. Rocha & Zaheer Kanji

  5. Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA

    Sharon Weber & Alexander Fisher

  6. Department of Surgery, Washington University School of Medicine, St. Louis, MI, USA

    Ryan Fields & Bradley A. Krasnick

  7. Division of Surgical Oncology, Department of Surgery, Vanderbilt University, Nashville, TN, USA

    Kamran Idrees & Paula Marincola-Smith

  8. Division of Hepatopancreatobiliary and Advanced Gastrointestinal Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI, USA

    Clifford Cho & Megan Beems

Authors
  1. Jeffery Chakedis
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  2. Eliza W. Beal
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  4. George Poultsides
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  7. Zaheer Kanji
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  8. Sharon Weber
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  9. Alexander Fisher
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  10. Ryan Fields
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  12. Kamran Idrees
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  13. Paula Marincola-Smith
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  14. Clifford Cho
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  15. Megan Beems
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  16. Timothy M. Pawlik
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  17. Shishir K Maithel
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  18. Carl R. Schmidt
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  19. Mary Dillhoff
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Contributions

Study Design: Jeffery Chakedis, Eliza W. Beal, Timothy M. Pawlik, Carl R. Schmidt, Mary Dillhoff.

Data Acquisition: Jeffery Chakedis, Eliza W. Beal, Alexandra G. Lopez-Aguiar, George Poultsides, Eleftherios Makris, Flavio G. Rocha, Zaheer Kanji, Sharon Weber, Alexander Fisher, Ryan Fields, Bradley A. Krasnick, Kamran Idrees, Paula Marincola-Smith, Clifford Cho, Megan Beems, Timothy M. Pawlik, Shishir K Maithel, Carl R. Schmidt, Mary Dillhoff.

Data Analysis/Interpretation: Jeffery Chakedis, Eliza W. Beal, Carl R. Schmidt, Mary Dillhoff.

Manuscript Preparation/Approval: Jeffery Chakedis, Eliza W. Beal, Alexandra G. Lopez-Aguiar, George Poultsides, Eleftherios Makris, Flavio G. Rocha, Zaheer Kanji, Sharon Weber, Alexander Fisher, Ryan Fields, Bradley A. Krasnick, Kamran Idrees, Paula Marincola-Smith, Clifford Cho, Megan Beems, Timothy M. Pawlik, Shishir K Maithel, Carl R. Schmidt, Mary Dillhoff.

Corresponding author

Correspondence to Mary Dillhoff.

Ethics declarations

The institutional review board from each institution approved the study

Conflict of Interest

The authors declare that they have no conflict of interest.

Electronic supplementary material

Supplemental Figure 1

Conditional overall survival of metastatic neuroendocrine tumor patients with non-hormonal symptoms who survived more than 1-year, n=302. (PDF 97 kb)

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Chakedis, J., Beal, E.W., Lopez-Aguiar, A.G. et al. Surgery Provides Long-Term Survival in Patients with Metastatic Neuroendocrine Tumors Undergoing Resection for Non-Hormonal Symptoms. J Gastrointest Surg 23, 122–134 (2019). https://doi.org/10.1007/s11605-018-3986-4

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  • DOI: https://doi.org/10.1007/s11605-018-3986-4

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