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Surgical therapy of neuroendocrine neoplasm with hepatic metastasis: patient selection and prognosis

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An Erratum to this article was published on 07 April 2015

Abstract

Background

Patients with neuroendocrine neoplasms (NEN) develop hepatic metastases in 50–95 %. The aims of this study were to evaluate the outcome/prognosis of patients following hepatic surgery and to identify predictive factors for the selection of patient that benefit from hepatic tumor resection.

Patients and methods

In a retrospective single-center study (1990 to 2014), 204 patients with hepatic metastasis of NEN were included. Ninety-four were subjected to various forms of liver resection. According to the overall survival, the influence of several prognostic factors like the Ki-67 index, stage of disease, and resection status was evaluated.

Results

The primary tumor was located in the small intestine (n = 73), pancreas (n = 58), colon (n = 26), esophagus or stomach (n = 9) and in 38 patients the primary site was unknown. The Ki-67 index was associated with significant different overall survival. Patients with an R0 resection (n = 38) of their hepatic metastasis had a very good 10-year survival of 90.4 %. Patients in whom an R1 (n = 23) or R2 (n = 33) resection of their hepatic metastasis could be achieved had a 10-year survival of 53.4 and 51.4 %, respectively. The majority of the patients (53.9 %) could not be resected and had a poor 10-year survival rate of 19.4 %. Partial or complete control of endocrine-related symptoms was achieved in all patients with functioning tumors following surgery. The overall 5- and 10-year survival rates were 77.9 and 65.2 %, respectively.

Conclusion

Surgical resection of hepatic NEN metastases can reduce symptoms and improve the survival in selected patients with a Ki-67 index less than 20 %. The expected outcome has to be compared to the outcome of alternative treatment strategies. An R0 situation should be the aim of hepatic surgery, but also patients with R1 or R2 resection show a good survival benefit.

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Acknowledgments

We thank Novartis for sponsoring the development of the database Software MaDoc.

Conflicts of interest

No potential conflicts of interest to be announced.

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Authors and Affiliations

  1. Clinic of General, Visceral- and Transplantation Surgery, University Medical Center Mainz, Langenbeckstr. 1, 55131, Mainz, Germany

    F. M. Watzka, H. Lang & T. J. Musholt

  2. Clinic of Endocrinology and Metabolic Diseases, University Medical Center Mainz, Langenbeckstr. 1, 55131, Mainz, Germany

    C. Fottner & M. M. Weber

  3. Clinic of Nuclear Medicine, University Medical Center Mainz, Langenbeckstr. 1, 55131, Mainz, Germany

    M. Miederer

  4. Institute of Pathology, University Medical Center Mainz, Langenbeckstr. 1, 55131, Mainz, Germany

    A. Schad

  5. Clinic of Transplantation Surgery, University Medical Center Mainz, Langenbeckstr. 1, 55131, Mainz, Germany

    G. Otto

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  1. F. M. Watzka
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  2. C. Fottner
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  3. M. Miederer
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  7. H. Lang
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  8. T. J. Musholt
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Correspondence to T. J. Musholt.

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Watzka, F.M., Fottner, C., Miederer, M. et al. Surgical therapy of neuroendocrine neoplasm with hepatic metastasis: patient selection and prognosis. Langenbecks Arch Surg 400, 349–358 (2015). https://doi.org/10.1007/s00423-015-1277-z

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  • DOI: https://doi.org/10.1007/s00423-015-1277-z

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