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Outcomes of Cytoreductive Surgery for Metastatic Low-Grade Neuroendocrine Tumors in the Setting of Extrahepatic Metastases

  • Endocrine Tumors
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Neuroendocrine tumors (NETs) have a uniquely indolent biology. Management focuses on tumor and hormonal burden reduction. Data on cytoreduction with extrahepatic disease remain limited.

Objective

We sought to define the outcomes of cytoreduction for metastatic NETs with extrahepatic metastases.

Methods

Patients undergoing cytoreductive surgery for grade 1 or 2 NETs with extrahepatic metastases (with or without intrahepatic disease) were identified from an institutional database (2003–2014). Primary outcomes included postoperative hormonal response (> 50% urinary 5HIAA decrease), progression-free survival (PFS) and overall survival (OS), while secondary outcomes were 30-day postoperative major morbidity (Clavien grade III–V), mortality, and length of stay.

Results

Fifty-five patients were identified (median age 59.3 years, 80% small bowel primaries, 56.4% grade 1); 87% of patients presented with combined intra- and extrahepatic metastases. Resection most commonly included the liver (87%), small bowel (22%), mesenteric (25%) and retroperitoneal (11%) lymph nodes, and peritoneum (7%). Thirty-day major morbidity (Clavien III–V) was 18%, with 3.6% mortality, and median length of stay was 7 days [interquartile range (IQR) 5–9]. Liver embolization was performed in 31% of patients after surgery, at a median of 23 months following surgery. Overall, postoperative hormonal response occurred in 70% of patients. At median follow-up of 37 months (IQR range 22–93), 42 (76%) patients were alive and 23 (41.8%) had progressed. Five-year OS was 77% and 5-year PFS was 51%.

Conclusion

Patients undergoing cytoreduction of metastatic well-differentiated NET in the setting of extrahepatic metastatic disease experience good tumoral control with favorable PFS and OS. Cytoreductive surgery can be safely included in the therapeutic armamentarium for NET with extrahepatic metastases.

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Funding

No sources of financial support have been received for this project.

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Authors and Affiliations

  1. Susan Leslie Multidisciplinary Clinic for Neuroendocrine Tumors, Odette Cancer Centre, Toronto, ON, Canada

    David L. Chan MBBS, Calvin H. L. Law MD, MPH, Simron Singh MD, MPH, Sten Myrehaug MD, MSc & Julie Hallet MD, MSc

  2. Division of Medical Oncology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada

    David L. Chan MBBS & Simron Singh MD, MPH

  3. Department of Surgery, University of Toronto, Toronto, ON, Canada

    Matthew Dixon MD, Calvin H. L. Law MD, MPH & Julie Hallet MD, MSc

  4. Division of General Surgery, Sunnybrook Health Sciences Centre, Toronto, ON, Canada

    Calvin H. L. Law MD, MPH & Julie Hallet MD, MSc

  5. Sunnybrook Research Institute, Toronto, ON, Canada

    Calvin H. L. Law MD, MPH, Serge Koujanian MD, Kaitlyn A. Beyfuss MSc(c), Simron Singh MD, MPH, Sten Myrehaug MD, MSc & Julie Hallet MD, MSc

  6. Division of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada

    Sten Myrehaug MD, MSc

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  1. David L. Chan MBBS
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  2. Matthew Dixon MD
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  8. Julie Hallet MD, MSc
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Correspondence to Julie Hallet MD, MSc.

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Disclosure

David L. Chan, Matthew Dixon, Calvin H.L. Law, Serge Koujanian, Kaitlyn A. Beyfuss, Simron Singh, Sten Myrehaug, and Julie Hallet have no commercial interests to declare for this study.

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Chan, D.L., Dixon, M., Law, C.H.L. et al. Outcomes of Cytoreductive Surgery for Metastatic Low-Grade Neuroendocrine Tumors in the Setting of Extrahepatic Metastases. Ann Surg Oncol 25, 1768–1774 (2018). https://doi.org/10.1245/s10434-018-6433-6

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  • DOI: https://doi.org/10.1245/s10434-018-6433-6

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