title: Long-term survival after surgical management of neuroendocrine hepatic metastases.
abstract: BACKGROUND
  Surgical cytoreduction and endocrine blockade are important options for care for neuroendocrine liver metastases. We investigated the long-term survival of patients surgically treated for hepatic neuroendocrine metastases.
  
  
  METHODS
  Patients (n= 172) undergoing operations for neuroendocrine liver metastases from any primary were identified from a prospective liver database. Recorded data and medical record review were used to analyse the type of procedure, length of hospital stay, peri-operative morbidity, tumour recurrence, progression,and survival.
  
  
  RESULTS
  The median age was 56.8 years (range 11.5-80.7 years). 48.3% of patients were female. Median overall survival was 9.6 years (range 89 days to 22 years). On multivariate analysis, lung/thymic primaries were associated with worse survival [hazard ratio (HR): 15.6, confidence interval (CI): 4.3-56.8, P= 0.002]. Severe post-operative complications were also associated with worse long-term survival (P < 0.001). A positive resection margin status (R1) was not associated with a worse overall survival probability (P approximately 0.8).
  
  
  CONCLUSIONS
  Early and aggressive surgical management of hepatic metastases from neuroendocrine tumours is associated with significant long-term survival rates. Radiofrequency ablation is a reasonable option if a lesion is unresectable. R1 resections, unlike many other cancers, are not associated with a worse overall survival.
authors.affiliation: Department of Surgical Oncology, The University of Texas M D Anderson Cancer Center, Houston, TX, USA.
authors.forename: Evan S
authors.initials: ES
authors.lastname: Glazer
authors.forename: Jennifer F
authors.initials: JF
authors.lastname: Tseng
authors.forename: Waddah
authors.initials: W
authors.lastname: Al-Refaie
authors.forename: Carmen C
authors.initials: CC
authors.lastname: Solorzano
authors.forename: Ping
authors.initials: P
authors.lastname: Liu
authors.forename: Katherine A
authors.initials: KA
authors.lastname: Willborn
authors.forename: Eddie K
authors.initials: EK
authors.lastname: Abdalla
authors.forename: Jean-Nicolas
authors.initials: JN
authors.lastname: Vauthey
authors.forename: Steven A
authors.initials: SA
authors.lastname: Curley
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017115:Catheter Ablation / Q000401:mortality; D016009:Chi-Square Distribution; D002648:Child; D002763:Cholecystectomy / Q000401:mortality; D013505:Digestive System Surgical Procedures / Q000401:mortality*; D005260:Female; D006498:Hepatectomy / Q000401:mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000401:mortality / Q000556:secondary / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D018358:Neuroendocrine Tumors / Q000401:mortality / Q000556:secondary / Q000601:surgery*; D016016:Proportional Hazards Models; D018570:Risk Assessment; D012307:Risk Factors; D015996:Survival Rate; D017741:Survivors / Q000706:statistics & numerical data*; D013781:Texas / Q000453:epidemiology; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult