title: Progression and survival results after radical hepatic metastasectomy of indolent advanced neuroendocrine neoplasms (NENs) supports an aggressive surgical approach.
abstract: BACKGROUND
  Neuroendocrine neoplasms most commonly metastasize to the liver. Operative extirpation of neuroendocrine neoplasm hepatic metastases improves symptoms and seems to improve survival, but subsequent evidence is required. The current study evaluates the progression-free survival and overall survival of patients after resection (with or without ablation) of neuroendocrine neoplasm hepatic metastases. As a secondary endpoint, the prognostic factors associated with progression-free survival and overall survival were evaluated.
  
  
  METHODS
  Seventy-four patients with neuroendocrine neoplasm hepatic metastases underwent hepatic resection between December 1992 and December 2009. Thirty-eight patients underwent synchronous cryoablation. Patients were assessed radiologically and serologically at monthly intervals for the first 3 months and then at 6-month intervals after treatment. Progression-free survival and overall survival were determined; clinicopathologic and treatment-related factors associated with progression-free survival and overall survival were evaluated through univariate and multivariate analyses.
  
  
  RESULTS
  No patient was lost to follow-up. The median follow-up for the patients who were alive was 41 months (range, 1-162). The median progression-free survival and overall survival after hepatic resection were 23 and 95 months, respectively. Five- and 10-year overall survival were 63% and 40%, respectively. Two independent factors were associated with overall survival: histologic grade (P < .001) and extrahepatic disease (P = .021). The only independent predictor for progression-free survival was pathologic margin status (P = .023).
  
  
  CONCLUSIONS
  In selected patients, aggressive operative extirpation of neuroendocrine neoplasm hepatic metastases is effective in achieving long-term survival. Disease progression, however, is a common occurrence; therefore, a multimodality treatment approach for progressive disease is necessary. Integrating the knowledge of identified prognostic factors can both improve patient selection and identify patients at greatest risk of treatment failure.
authors.affiliation: Department of Surgery, St George Hospital, The University of New South Wales, Kogarah, Sydney, Australia.
authors.forename: Akshat
authors.initials: A
authors.lastname: Saxena
authors.forename: Terence C
authors.initials: TC
authors.lastname: Chua
authors.forename: Anik
authors.initials: A
authors.lastname: Sarkar
authors.forename: Francis
authors.initials: F
authors.lastname: Chu
authors.forename: Winston
authors.initials: W
authors.lastname: Liauw
authors.forename: Jing
authors.initials: J
authors.lastname: Zhao
authors.forename: David L
authors.initials: DL
authors.lastname: Morris
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018572:Disease-Free Survival; D005260:Female; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality / Q000556:secondary* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D018358:Neuroendocrine Tumors / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D011379:Prognosis