Original CommunicationProgression and survival results after radical hepatic metastasectomy of indolent advanced neuroendocrine neoplasms (NENs) supports an aggressive surgical approach
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.
References (19)
- et al.
A 5-decade analysis of 13,715 carcinoid tumors
Cancer
(2003) - COSA. Australian neuroendocrine tumours (NETs) consensus workshop meeting management challenges in Australia. In: Evans...
- et al.
Prospective, randomized, multicenter trial on the antiproliferative effect of lanreotide, interferon alfa, and their combination for therapy of metastatic neuroendocrine gastroenteropancreatic tumors–the international lanreotide and interferon alfa study group
J Clin Oncol
(2003) - et al.
Placebo-controlled, double-blind, prospective, randomized study on the effect of octreotide lar in the control of tumor growth in patients with metastatic neuroendocrine midgut tumors: a report from the PROMID Study Group
J Clin Oncol
(2009) - et al.
Histologic grade is correlated with outcome after resection of hepatic neuroendocrine neoplasms
Cancer
(2008) - et al.
Hepatic ablation for neuroendocrine tumor metastases
J Surg Oncol
(2009) - et al.
Hepatic neuroendocrine metastases: does intervention alter outcomes?
J Am Coll Surg
(2000) - et al.
Activity of sunitinib in patients with advanced neuroendocrine tumors
J Clin Oncol
(2008) - et al.
Treatment of liver metastases from neuroendocrine tumours in relation to the extent of hepatic disease
Br J Surg
(2009)
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2022, Translational OncologyCitation Excerpt :Although most GEP-NENs are low-grade tumours, diagnosis is often delayed because the symptoms are unspecific. Hence, GEP-NENs are mostly diagnosed at an advanced stage by which point 40–95% of tumours have metastasised [7]. Despite recent advances in diagnostics and therapy, treatment options for nonresectable, metastatic, or aggressive G3-GEP-NECs are still limited.
Treatment strategies for neuroendocrine liver metastases: a systematic review
2022, HPBCitation Excerpt :Although these results involve a lower chance of surgical resection, these two types may undergo locoregional treatment followed by resection, or staged hepatectomy.38 In fact, many reports have shown the advantages regarding survival and symptom control by surgical resection, superior to other treatments, as reported by the reviewed studies.8–19 Additionally, some authors reported the feasibility of performing the combined resection of the primary tumor with metastases to obtain the complete resection R0.
Does surgery provide a survival advantage in non-disseminated poorly differentiated gastroenteropancreatic neuroendocrine neoplasms?
2021, Surgery (United States)Citation Excerpt :It may be that WHO Grade 3 lesions also benefit from resection of the primary lesion even when occult metastases are present, given that in our study survival was improved after resection, with approximately a quarter of patients who were clinically M0 were observed to have metastases on final pathology. Nonetheless, metastasectomy has not been recommended in NEC as survival after hepatectomy for metastatic PD-GEP-NEN is estimated at 6 to 15 months.17,18 It is important to acknowledge the potential limitations in our study.