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Management of Ileal Neuroendocrine Tumors with Liver Metastases

  • Original Article
  • Published:
Journal of Gastrointestinal Surgery

Abstract

Purpose

Assessment of treating metastatic ileal neuroendocrine tumors (NETs) with complete resection of primary tumor, nodal and liver metastases, plus administration of long-acting somatostatin analogues (SSAs).

Methods

A prospective database was queried for patients with ileal or pancreatic NETs with pathology-confirmed liver metastases and tumor somatostatin receptors. Patients did not have MEN-1 and had no previous treatment. The impacts of SSA treatment on the primary outcome of survival and secondary outcome of progression-free survival were assessed with Kaplan–Meier analysis. Log rank test was used to compare overall and progression-free survival among groups.

Results

Seventeen ileal NET patients and 36 pancreatic NET patients who underwent surgical resection between 2001 and 2018, who had pathology-confirmed liver metastases and confirmed tumor somatostatin receptors, did not have MEN-1, and had no previous treatment were identified. Median follow-up for patients with ileal NETs was 80 months (range 0–197 months) and 32 months (range 1–182 months) for pancreatic NETs. Five-year survival was 93% and 72% for ileal and pancreatic NET, respectively. Progression-free 5-year survival was 70% and 36% for ileal and pancreatic NET, respectively. Overall 5-year survival for pNETs was greater in those patients treated with SSA (79%) compared to those who underwent surgery alone (34%, p < 0.01). The average ECOG score was low for surviving patients with ileal (0.15) and pancreatic NET (0.73) indicating a good quality of life.

Conclusions

Resection of primary lymph node and liver metastatic ileal or pancreatic NETs followed with continued SSAs is associated with an excellent progression-free and overall survival and minimal side effects.

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Authors and Affiliations

  1. Department of Surgery, Stanford University Hospital, 875 Blake Wilbur Drive, Stanford, CA, 94305, USA

    Andrea T. Fisher, Ashley L. Titan, Deshka S. Foster, Patrick J. Worth, George A. Poultsides, Brendan C. Visser, Monica M. Dua & Jeffrey A. Norton

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  1. Andrea T. Fisher
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Contributions

Dr. Jeffrey Norton surgically treated the participants, devised the research plan, and revised the manuscript.

Andrea Fisher collected data from ileal patient records, performed analysis, developed figures for ileal patients, and drafted the manuscript.

Dr. Ashley Titan performed analysis of patient records, developed figures for pancreatic patients, and revised the manuscript.

Dr. Deshka Foster facilitated data analysis and figure creation for the ileal patients.

Dr. Patrick Worth collected data from pancreatic patient records.

Dr. George Poultsides surgically treated the participants, facilitated with devising the research plan, and revised the manuscript.

Dr. Brendan Visser surgically treated the participants and revised the manuscript.

Dr. Monica Dua surgically treated the participants and revised the manuscript.

Corresponding author

Correspondence to Jeffrey A. Norton.

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The authors declare that they have no conflicts of interest.

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This paper was presented as a poster at the SSAT meeting, Digestive Disease week, San Diego, CA. May 19, 2019.

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Fisher, A.T., Titan, A.L., Foster, D.S. et al. Management of Ileal Neuroendocrine Tumors with Liver Metastases. J Gastrointest Surg 24, 1530–1539 (2020). https://doi.org/10.1007/s11605-019-04309-7

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  • DOI: https://doi.org/10.1007/s11605-019-04309-7

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