title: Optimizing the surgical effort in patients with advanced neuroendocrine neoplasm hepatic metastases: a critical analysis of 40 patients treated by hepatic resection and cryoablation.
abstract: BACKGROUND
  Surgical extirpation of neuroendocrine neoplasms hepatic metastases (NENHM) provides the best opportunity of long-term survival but is not feasible in the majority of patients given the widespread presentation of liver disease. Combining resection with local ablation can potentially expand the resection criteria and thereby improve survival. The present study critically evaluates the progression-free survival (PFS) and overall survival (OS) of patients with NENHM who underwent concomitant hepatic resection and cryoablation.
  
  
  METHODS
  Forty patients with NENHM underwent concomitant hepatic resection and cryoablation between December 1992 and June 2010. PFS and OS were determined; clinicopathologic and treatment-related factors associated with PFS and OS were evaluated through univariate and multivariate analyses.
  
  
  RESULTS
  The median follow-up for the patients who were alive was 61 months (range, 1 to 162 mo). The median PFS and OS after hepatic resection were 22 and 95 months, respectively. Five-year and 10-year OS rate was 61% and 40%, respectively. One independent factor was associated with OS: histologic grade (P=0.001). One independent factor was associated with PFS: extrahepatic disease (P=0.003).
  
  
  CONCLUSIONS
  Concomitant hepatic resection and cryoablation to achieve tumor debulking is associated with excellent survival outcomes in selected patients. This approach may increase the number of patients with borderline resectable disease undergoing surgical management of advanced NENHM.
authors.affiliation: Hepatobiliary and Surgical Oncology Unit, UNSW Department of Surgery, St George Hospital, Kogarah, Sydney, Australia.
authors.forename: Akshat
authors.initials: A
authors.lastname: Saxena
authors.forename: Terence C
authors.initials: TC
authors.lastname: Chua
authors.forename: Francis
authors.initials: F
authors.lastname: Chu
authors.forename: Abdulaziz
authors.initials: A
authors.lastname: Al-Zahrani
authors.forename: David L
authors.initials: DL
authors.lastname: Morris
mesh_terms: D000328:Adult; D000368:Aged; D003131:Combined Modality Therapy; D003452:Cryosurgery; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy / Q000401:mortality*; D006801:Humans; D008113:Liver Neoplasms / Q000556:secondary / Q000601:surgery* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D018358:Neuroendocrine Tumors / Q000473:pathology / Q000601:surgery* / Q000628:therapy; D015996:Survival Rate; D016896:Treatment Outcome