Surgical Management of Hepatic Neuroendocrine Tumor Metastasis: Results from an International Multi-Institutional Analysis
- 1.8k Downloads
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.
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.
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).
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.
KeywordsHepatic Resection Neuroendocrine Tumor Liver Operation Extrahepatic Disease Hormonal Symptom
Dr. Pawlik has served as a consultant to Bayer-Onyx. Dr. Choti is the Johns Hopkins University institutional principal investigator for clinical trials sponsored by Ipsen Corporation.
- 12.Strasberg SM. The International Hepato-Pancreato-Biliary Association. The Brisbane 2000 terminology of liver anatomy and resections. HBP. 2000;2(3):333–9.Google Scholar
- 14.Cox D. Regression models and life tables. J R Stat Soc B. 1972;34:187–220.Google Scholar
- 15.Hosmer DW, Lemeshow S. Applied survival analysis: regression modeling of time to event data. 2nd ed. New York: Wiley; 1999.Google Scholar
- 18.de Jong MC, Mayo SC, Pulitano C, et al. Repeat curative intent liver surgery is safe and effective for recurrent colorectal liver metastasis: results from an international multi-institutional analysis. J Gastrointest Surg. 2009;250(3):440–8.Google Scholar