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Annals of Surgical Oncology

, Volume 17, Issue 12, pp 3129–3136 | Cite as

Surgical Management of Hepatic Neuroendocrine Tumor Metastasis: Results from an International Multi-Institutional Analysis

  • Skye C. Mayo
  • Mechteld C. de Jong
  • Carlo Pulitano
  • Brian M. Clary
  • Srinevas K. Reddy
  • T. Clark Gamblin
  • Scott A. Celinksi
  • David A. Kooby
  • Charles A. Staley
  • Jayme B. Stokes
  • Carrie K. Chu
  • Alessandro Ferrero
  • Richard D. Schulick
  • Michael A. Choti
  • Giles Mentha
  • Jennifer Strub
  • Todd W. Bauer
  • Reid B. Adams
  • Luca Aldrighetti
  • Lorenzo Capussotti
  • Timothy M. Pawlik
Hepatobiliary Tumors

Abstract

Background

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.

Methods

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.

Results

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).

Conclusions

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.

Keywords

Hepatic Resection Neuroendocrine Tumor Liver Operation Extrahepatic Disease Hormonal Symptom 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Disclosures

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.

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Copyright information

© Society of Surgical Oncology 2010

Authors and Affiliations

  • Skye C. Mayo
    • 1
  • Mechteld C. de Jong
    • 1
  • Carlo Pulitano
    • 2
  • Brian M. Clary
    • 3
  • Srinevas K. Reddy
    • 3
  • T. Clark Gamblin
    • 4
  • Scott A. Celinksi
    • 4
  • David A. Kooby
    • 5
  • Charles A. Staley
    • 5
  • Jayme B. Stokes
    • 7
  • Carrie K. Chu
    • 5
  • Alessandro Ferrero
    • 8
  • Richard D. Schulick
    • 1
  • Michael A. Choti
    • 1
  • Giles Mentha
    • 6
  • Jennifer Strub
    • 6
  • Todd W. Bauer
    • 7
  • Reid B. Adams
    • 7
  • Luca Aldrighetti
    • 2
  • Lorenzo Capussotti
    • 8
  • Timothy M. Pawlik
    • 1
  1. 1.Department of SurgeryJohns Hopkins University School of MedicineBaltimoreUSA
  2. 2.Ospedale San RaffaeleMilanItaly
  3. 3.Duke Medical CenterDurhamUSA
  4. 4.University of PittsburghPittsburghUSA
  5. 5.Emory University School of MedicineAtlantaUSA
  6. 6.Hôpitaux Universitaires de GenèveGenevaSwitzerland
  7. 7.University of VirginiaCharlottesvilleUSA
  8. 8.Ospedale Mauriziano Umberto ITurinItaly

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