Elsevier

Surgery

Volume 149, Issue 2, February 2011, Pages 209-220
Surgery

Original Communication
Progression and survival results after radical hepatic metastasectomy of indolent advanced neuroendocrine neoplasms (NENs) supports an aggressive surgical approach

https://doi.org/10.1016/j.surg.2010.06.008Get rights and content

Background

Neuroendocrine neoplasms most commonly metastasize to the liver. Operative extirpation of neuroendocrine neoplasm hepatic metastases improves symptoms and seems to improve survival, but subsequent evidence is required. The current study evaluates the progression-free survival and overall survival of patients after resection (with or without ablation) of neuroendocrine neoplasm hepatic metastases. As a secondary endpoint, the prognostic factors associated with progression-free survival and overall survival were evaluated.

Methods

Seventy-four patients with neuroendocrine neoplasm hepatic metastases underwent hepatic resection between December 1992 and December 2009. Thirty-eight patients underwent synchronous cryoablation. Patients were assessed radiologically and serologically at monthly intervals for the first 3 months and then at 6-month intervals after treatment. Progression-free survival and overall survival were determined; clinicopathologic and treatment-related factors associated with progression-free survival and overall survival were evaluated through univariate and multivariate analyses.

Results

No patient was lost to follow-up. The median follow-up for the patients who were alive was 41 months (range, 1–162). The median progression-free survival and overall survival after hepatic resection were 23 and 95 months, respectively. Five- and 10-year overall survival were 63% and 40%, respectively. Two independent factors were associated with overall survival: histologic grade (P < .001) and extrahepatic disease (P = .021). The only independent predictor for progression-free survival was pathologic margin status (P = .023).

Conclusion

In selected patients, aggressive operative extirpation of neuroendocrine neoplasm hepatic metastases is effective in achieving long-term survival. Disease progression, however, is a common occurrence; therefore, a multimodality treatment approach for progressive disease is necessary. Integrating the knowledge of identified prognostic factors can both improve patient selection and identify patients at greatest risk of treatment failure.

Section snippets

Patients and methods

We reviewed the records of 74 consecutive patients with histologically confirmed NEN hepatic metastases (NENHMs) who underwent resection (with or without cryoablation) from a prospective database. All procedures were performed at the Hepatobiliary Service of the University of New South Wales, Department of Surgery, St George Hospital during a 17-year period between December 1992 and December 2009. Patients were evaluated with a baseline medical history, clinical examination, serum laboratory

Results

Between December 1992 and December 2009, a total of 74 patients underwent hepatic resection (with or without ablation) for NENHMs. Another 12 patients underwent laparotomy but were deemed unresectable on exploration.

Of the 74 patients, there were 37 (50%) male patients. The mean age of patients at the time of resection was 59 ± 12 years (range, 28–83). Thirty-two (43%) patients presented with symptoms relating to hormone excess secondary to NENs. The site of the primary neoplasm was the small

Discussion

NENs, even when metastatic to the liver, are regarded commonly as relatively indolent in their biologic activity. Often, patients experience significant morbidity with incapacitating symptoms, however, related to hepatic neoplasm burden and excessive hormone production. In particular, hepatic metastases from carcinoid neoplasms often cause excessive serotonin production inducing carcinoid syndrome, which is typically characterized by diarrhea, episodic flushing, tachycardia, and bronchospasm.

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