Surgical management of hepatic neuroendocrine tumor metastasis: results from an international multi-institutional analysis.
BACKGROUND
Management of neuroendocrine tumor liver metastasis (NELM) remains controversial, with some advocating an aggressive surgical approach while others have adopted a more conservative strategy. We sought to define the efficacy of the surgical management of NELM in a large multicenter international cohort of patients.


METHODS
We identified 339 patients who underwent surgical management for NELM from 1985 to 2009 from an international database of eight major hepatobiliary centers. Relevant clinicopathologic data were assessed using Kaplan-Meier and Cox regression models.


RESULTS
Most patients had a pancreatic (40%) or small bowel (25%) neuroendocrine tumor (NET) primary. The majority of patients (60%) had bilateral liver disease. At surgery, 78% of patients underwent hepatic resection, 3% ablation alone, and 19% resection + ablation. Major hepatectomy was performed in 45% of patients, and 14% underwent a second liver operation. Carcinoid was the most common NET histological subtype (53%). Median survival was 125 months, with overall 5- and 10-year survival of 74%, and 51%, respectively. Disease recurred in 94% of patients at 5 years. Patients with hormonally functional NET who had R0/R1 resection benefited the most from surgery (P = 0.01). On multivariate analyses, synchronous disease [hazard ratio (HR) = 1.9], nonfunctional NET hormonal status (HR = 2.0), and extrahepatic disease (HR = 3.0) remained predictive of worse survival (all P < 0.05).


CONCLUSIONS
Liver-directed surgery for NELM is associated with prolonged survival; however, the majority of patients will develop recurrent disease. Patients with hormonally functional hepatic metastasis without prior extrahepatic or synchronous disease derive the greatest survival benefit from surgical management.
Mayo
Skye C
SC
Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
de Jong
Mechteld C
MC
Pulitano
Carlo
C
Clary
Brian M
BM
Reddy
Srinevas K
SK
Gamblin
T Clark
TC
Celinksi
Scott A
SA
Kooby
David A
DA
Staley
Charles A
CA
Stokes
Jayme B
JB
Chu
Carrie K
CK
Ferrero
Alessandro
A
Schulick
Richard D
RD
Choti
Michael A
MA
Mentha
Giles
G
Strub
Jennifer
J
Bauer
Todd W
TW
Adams
Reid B
RB
Aldrighetti
Luca
L
Capussotti
Lorenzo
L
Pawlik
Timothy M
TM
D015331:Cohort Studies; D005260:Female; D006498:Hepatectomy; D006801:Humans; D007390:International Agencies; D008113:Liver Neoplasms / Q000556:secondary / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D018358:Neuroendocrine Tumors / Q000473:pathology / Q000601:surgery*; D015996:Survival Rate; D016896:Treatment Outcome