title: Hepatic resection for metastatic gastrointestinal and pancreatic neuroendocrine tumours: outcome and prognostic predictors.
abstract: BACKGROUND
  Treatment modalities for hepatic metastases from neuroendocrine tumours (NETs) include surgery, somatostatin analogues and arterial embolization. The aims of this study were to evaluate the outcome of patients following surgery and to identify prognostic predictors of recurrent disease.
  
  
  METHODS
  This was a retrospective clinico-pathological analysis of patients managed with hepatic NET metastases over a 13-year period (January 1994 to December 2006).
  
  
  RESULTS
  Eighteen patients with hepatic metastases from NET were identified with a median age of 53 years (range 31-75). The localization of the primary tumour was the terminal ileum (n=8), pancreas (n=7), appendix (n=2) or duodenum (n=1). Twelve patients had synchronous disease and six patients developed metachronous hepatic tumours over a median period of 20 months (range 6-144). Presenting symptoms included abdominal pain (n =13), recurrent diarrhoea (n=7) and flushing (n=7). Fifteen patients underwent surgery with complete cytoreduction and three patients had partial cytoreduction. The overall 2- and 5-year actuarial survival rates were 94% and 86%, respectively. The 2- and 5-year disease-free rates following hepatic resection with complete cytoreduction were both 66%. Partial or complete control of endocrine-related symptoms was achieved in all patients with functioning tumours following surgery. Recurrent disease occurred in four patients following complete cytoreductive surgery. Resection margin involvement was associated with developing recurrent disease (p=0.041).
  
  
  CONCLUSIONS
  Surgical resection for hepatic NET metastases results in good long-term survival in selected patients and resection margin involvement was associated with recurrent disease.
authors.affiliation: Hepatobiliary and Transplantation Unit, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
authors.forename: D
authors.initials: D
authors.lastname: Gomez
authors.forename: H Z
authors.initials: HZ
authors.lastname: Malik
authors.forename: A
authors.initials: A
authors.lastname: Al-Mukthar
authors.forename: K V
authors.initials: KV
authors.lastname: Menon
authors.forename: G J
authors.initials: GJ
authors.lastname: Toogood
authors.forename: J P A
authors.initials: JP
authors.lastname: Lodge
authors.forename: K R
authors.initials: KR
authors.lastname: Prasad