Abstract
Background
Liver resection in patients with neuroendocrine liver metastasis (NELM) provides a survival benefit, yet the optimal extent of resection remains unknown. We sought to examine outcomes of patients undergoing non-anatomic (NAR) versus anatomic liver resection (AR) for NELM using a large international cohort of patients.
Methods
Two hundred and fifty-eight patients who underwent curative intent liver resection from January 1990 to December 2016 were identified from eight institutions. Patients were excluded if they underwent concurrent ablation, had extrahepatic disease, underwent a debulking operation, or had mixed anatomic and non-anatomic resections. Overall (OS) and recurrence-free (RFS) survival were compared among patients based on the extent of liver resection (AR vs. NAR).
Results
Most primary tumors were located in the pancreas (n = 117, 45.4%) or the small intestine (n = 65, 25.2%). Liver resection consisted of NAR (n = 126, 48.8%) or AR (n = 132, 51.2%) resection. The overwhelming majority of patients who underwent NAR had an estimated liver involvement of < 50% (NAR 109, 97.3% vs. AR n = 82, 65.6%; P < 0.001). Patients who underwent NAR also had higher rates of primary tumor lymph node metastasis (NAR n = 79, 71.2% vs. AR n = 37, 33.6%; P < 0.001) and microscopically positive margins (R1) (NAR n = 29, 25.7% vs. AR n = 16, 12.5%; P = 0.009). After a median follow-up of 47.7 months, 48 (18.6%) patients died and 37.0% (n = 95) had evidence of disease recurrence. Patients who underwent AR had both longer median OS (not reached) and RFS (not reached) versus patients who underwent NAR (median OS 138.3 months; median RFS 31.3 months) (both P < 0.01). After controlling for patient and disease-related factors, extent of liver resection was independently associated with an increased risk of recurrence (HR 2.39, 95% CI 1.04–5.48; P = 0.04) but not death (HR 1.92, 95% CI 0.40–9.28; P = 0.42).
Conclusion
NAR was independently associated with a higher incidence of recurrence versus patients who undergo a formal anatomic hepatectomy among patients with NELM.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Spolverato G, Bagante F, Wagner D, et al. Quality of life after treatment of neuroendocrine liver metastasis. J Surg Res. 2015;198(1):155–164.
Thompson GB, van Heerden JA, Grant CS, Carney JA, Ilstrup DM. Islet cell carcinomas of the pancreas: a twenty-year experience. Surgery. 1988;104(6):1011–1017.
Mayo SC, de Jong MC, Pulitano C, et al. Surgical management of hepatic neuroendocrine tumor metastasis: results from an international multi-institutional analysis. Ann Surg Oncol. 2010;17(12):3129–3136.
Farley HA, Pommier RF. Treatment of Neuroendocrine Liver Metastases. Surg Oncol Clin N Am. 2016;25(1):217–225.
Tang H, Li B, Zhang H, Dong J, Lu W. Comparison of Anatomical and Nonanatomical Hepatectomy for Colorectal Liver Metastasis: A Meta-Analysis of 5207 Patients. Sci Rep. 2016;6:32304.
Margonis GA, Buettner S, Andreatos N, et al. Anatomical Resections Improve Disease-free Survival in Patients With KRAS-mutated Colorectal Liver Metastases. Ann Surg. 2017;266(4):641–649.
DeMatteo RP, Palese C, Jarnagin WR, Sun RL, Blumgart LH, Fong Y. Anatomic segmental hepatic resection is superior to wedge resection as an oncologic operation for colorectal liver metastases. J Gastrointest Surg. 2000;4(2):178–184.
Lee SY, Cheow PC, Teo JY, Ooi LL. Surgical treatment of neuroendocrine liver metastases. Int J Hepatol. 2012;2012:146590.
Musunuru S, Chen H, Rajpal S, et al. Metastatic neuroendocrine hepatic tumors: resection improves survival. Arch Surg. 2006;141(10):1000–1004; discussion 1005.
Ejaz A, Reames BN, Maithel S, et al. Cytoreductive debulking surgery among patients with neuroendocrine liver metastasis: a multi-institutional analysis. HPB (Oxford). 2017.
Ejaz A, Reames BN, Maithel S, et al. The impact of extrahepatic disease among patients undergoing liver-directed therapy for neuroendocrine liver metastasis. J Surg Oncol. 2017;116(7):841–847.
Klimstra DS, Modlin IR, Coppola D, Lloyd RV, Suster S. The pathologic classification of neuroendocrine tumors: a review of nomenclature, grading, and staging systems. Pancreas. 2010;39(6):707–712.
Touzios JG, Kiely JM, Pitt SC, et al. Neuroendocrine hepatic metastases: does aggressive management improve survival? Ann Surg. 2005;241(5):776–783; discussion 783–775.
Glazer ES, Tseng JF, Al-Refaie W, et al. Long-term survival after surgical management of neuroendocrine hepatic metastases. HPB (Oxford). 2010;12(6):427–433.
Lesurtel M, Nagorney DM, Mazzaferro V, Jensen RT, Poston GJ. When should a liver resection be performed in patients with liver metastases from neuroendocrine tumours? A systematic review with practice recommendations. HPB (Oxford). 2015;17(1):17–22.
Hibi T, Sano T, Sakamoto Y, et al. Surgery for hepatic neuroendocrine tumors: a single institutional experience in Japan. Jpn J Clin Oncol. 2007;37(2):102–107.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
The Institutional Review Board of the participating institutions deemed this study exempt for review.
Rights and permissions
About this article
Cite this article
Sham, J.G., Ejaz, A., Gage, M.M. et al. The Impact of Extent of Liver Resection Among Patients with Neuroendocrine Liver Metastasis: an International Multi-institutional Study. J Gastrointest Surg 23, 484–491 (2019). https://doi.org/10.1007/s11605-018-3862-2
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11605-018-3862-2