title: Liver resection (and associated extrahepatic resections) for metastatic well-differentiated endocrine tumors: a 15-year single center prospective study.
abstract: BACKGROUND
  The timing and benefits of hepatectomy remain controversial for metastatic well-differentiated endocrine neoplasms, which are generally considered slow growth tumors. However, surveillance alone yields only a 22% 5-year survival when metastases occur. The aim of this study was to determine the results of hepatic and extra hepatic resections and to clarify the indications of surgery.
  
  
  METHODS
  To define the role of hepatic resection, a database regrouping all patients (n = 47) who underwent hepatectomy with curative intent (R0 status) for well-differentiated endocrine neoplasms in the Gustave-Roussy Institute was constructed in 1984. New prognostic factors such as tumor growth and liver tumor mitotic index were studied. Median follow-up was 62 months.
  
  
  RESULTS
  Hepatectomy was associated with extrahepatic tumor resection in 77% of the patients (primary tumor in 51%, lymph nodes in 21%, peritoneal carcinomatosis in 25%, and other in 6%). Resection was curative (R0) only in 53% of the patients, despite removing at least 97% of the tumor in each patient. Mortality was 5%, and morbidity was 45%. Median survival was 91 months, 5-year and 10-year overall survival rates were 71% and 35%, respectively. Liver recurrence rate was 75% at 10 years. No prognostic factor was correlated with overall survival in this population in which at least 97% of the tumor load was resected. The completeness of surgery, the presence of bilateral liver metastases, the number of liver metastases (>10) and a primary tumor from pancreatic origin were all significantly correlated with the disease-free survival. Preoperative tumor growth rate, mitotic index, and Ki67 expression were not predictive of prognosis. No significant prognostic factors could be found by the comparison of the patients who did and did not recur during the 3 years after hepatectomy.
  
  
  CONCLUSIONS
  Hepatectomy for liver metastases from well-differentiated endocrine neoplasms is indicated when all visible intra- and extra hepatic lesions can be resected safely. The number, size, and localization of the tumor sites are less important than performing a complete (or near-complete) resection.
authors.affiliation: Department of Surgical Oncology, Comprehensive Cancer Center, Institut Gustave Roussy, Rue Camille Desmoulins, 94805 Villejuif Cedex, France.
authors.forename: Dominique
authors.initials: D
authors.lastname: Elias
authors.forename: Philippe
authors.initials: P
authors.lastname: Lasser
authors.forename: Michel
authors.initials: M
authors.lastname: Ducreux
authors.forename: Pierre
authors.initials: P
authors.lastname: Duvillard
authors.forename: Jean-Francois
authors.initials: JF
authors.lastname: Ouellet
authors.forename: Clarice
authors.initials: C
authors.lastname: Dromain
authors.forename: Martin
authors.initials: M
authors.lastname: Schlumberger
authors.forename: Marc
authors.initials: M
authors.lastname: Pocard
authors.forename: Valérie
authors.initials: V
authors.lastname: Boige
authors.forename: Catherine
authors.initials: C
authors.lastname: Miquel
authors.forename: Eric
authors.initials: E
authors.lastname: Baudin
mesh_terms: D000328:Adult; D000368:Aged; D002454:Cell Differentiation; D015179:Colorectal Neoplasms / Q000401:mortality / Q000473:pathology; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy / Q000401:mortality*; D006801:Humans; D015994:Incidence; D007414:Intestinal Neoplasms / Q000401:mortality / Q000473:pathology; D008099:Liver / Q000473:pathology / Q000601:surgery; D008113:Liver Neoplasms / Q000401:mortality* / Q000556:secondary*; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000556:secondary; D010190:Pancreatic Neoplasms / Q000401:mortality* / Q000473:pathology*; D011379:Prognosis; D011446:Prospective Studies