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Examining Perioperative Risk Associated with Simultaneous Resection of Primary Neuroendocrine Tumors and Synchronous Hepatic Metastases

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Abstract

Background

Surgical debulking of primary neuroendocrine tumors (NETs) and hepatic resection of metastatic NET disease may each independently improve overall survival. However, evidence for combined primary site debulking and metastasectomy on survival and impact on short-term perioperative outcomes is limited.

Methods

The 2014–2016 ACS-NSQIP targeted hepatectomy database was queried for all patients undergoing liver resection for metastatic NET. Secondary procedure codes were evaluated for major concurrent operations. Multivariable analysis was performed to determine risk factors for 30-day morbidity and mortality.

Results

A total of 472 patients were identified, of whom 153 (32.4%) underwent ≥1 additional concurrent major operation. The most common concurrent procedures were small bowel resection (14.6%), partial colectomy (8.9%), and radical lymphadenectomy (7.4%). Among all patients, overall 30-day mortality and morbidity were 1.5% and 25.6%, respectively. Modifiable and treatment-related factors associated with increased major postoperative morbidity risk included >10% weight loss within six months of surgery (p = 0.05), increasing number of hepatic lesions treated (p = 0.05), and biliary reconstruction (p = 0.001). No major concurrent procedure was associated with increased 30-day morbidity (all p > 0.05).

Conclusions

Approximately one-third of patients with stage IV NET underwent combined hepatic and multi-organ resection. Although modifiable and treatment-related factors predictive of perioperative morbidity were identified, performance of concurrent major procedures did not increase perioperative morbidity. These results support consideration of multi-organ resection in carefully selected patients with metastatic NET.

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Funding

There were no internal or external sources of funding for this project.

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Authors and Affiliations

  1. Department of Surgery, William Beaumont Army Medical Center, 5005 N. Piedras St, El Paso, TX, 79920, USA

    Bethany M. Heidenreich, Remigio J. Flor & Daniel W. Nelson

  2. Department of Surgery, Brooke Army Medical Center, 3551 Roger Brooke Dr, San Antonio, TX, 78234, USA

    Phillip M. Kemp Bohan & Timothy J. Vreeland

  3. Department of Clinical Investigation, William Beaumont Army Medical Center, 5005 N. Piedras St, El Paso, TX, 79920, USA

    Julia O. Bader

  4. Department of Surgery, Kaiser Permanente Los Angeles Medical Center, 4867 Sunset Blvd, Los Angeles, CA, 90027, USA

    Victoria V. O’Connor

Authors
  1. Bethany M. Heidenreich
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  2. Phillip M. Kemp Bohan
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  3. Remigio J. Flor
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  4. Julia O. Bader
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  5. Timothy J. Vreeland
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  6. Victoria V. O’Connor
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  7. Daniel W. Nelson
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Contributions

All authors have made substantial contributions to the conception and design of the work; acquisition, analysis, and interpretation of data for the work; drafting the work or providing critical revisions; and all approved of the final version to be published. All authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Corresponding author

Correspondence to Daniel W. Nelson.

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Conflicts of interest

The American College of Surgeons National Surgical Quality Improvement Program and the hospitals participating in the ACS-NSQIP are the source of the data used herein; they have not verified and are not responsible for the statistical validity of the data analysis or the conclusions derived by the authors.

Ethical approval

This study was granted exemption status after review by an independent institutional review board.

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The results and opinions expressed in this article are those of the authors, and do not reflect the opinions or official policy of the United States Army or the Department of Defense.

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Heidenreich, B.M., Kemp Bohan, P.M., Flor, R.J. et al. Examining Perioperative Risk Associated with Simultaneous Resection of Primary Neuroendocrine Tumors and Synchronous Hepatic Metastases. World J Surg 45, 531–542 (2021). https://doi.org/10.1007/s00268-020-05847-x

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  • DOI: https://doi.org/10.1007/s00268-020-05847-x

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