title: Resection of liver metastasis from neuroendocrine tumors: evaluation of results and prognostic factors.
abstract: OBJECTIVE
  to determine the prognostic factors that may impact on morbidity and mortality and survival of patients undergoing surgical treatment of liver metastases from neuroendocrine tumors.
  
  
  METHODS
  We studied 22 patients undergoing liver resection for metastases from neuroendocrine tumors between 1997 and 2007. Epidemiological and clinical data were correlated with morbidity and mortality and overall and disease-free survivals.
  
  
  RESULTS
  twelve patients were male and ten female, with a mean age of 48.5 years. Bilobar disease was present in 17 patients (77.3%). In ten patients (45.5%) the primary tumor originated in the pancreas, terminal ileum in eight, duodenum in two, rectum in one and jejunum in one. Complete surgical resection (R0) was achieved in 59.1% of patients. Eight patients (36.3%) developed complications in the immediate postoperative period, one of them dying from septicemia. All patients undergoing re-hepatectomy and/or two-stage hepatectomy had complications in the postoperative period. The overall survival at one and five years was 77.3% and 44.2%. The disease-free survival at five years was 13.6%. The primary pancreatic neuroendocrine tumor (p = 0.006) was associated with reduced overall survival. Patients with number of metastatic nodules < 10 (p = 0.03) and asymptomatic at diagnosis (p = 0.015) had higher disease-free survival.
  
  
  CONCLUSIONS
  liver metastases originating from pancreatic neuroendocrine tumors proved to be a negative prognostic factor. Symptomatic patients with multiple metastatic nodules showed a significant reduction in disease-free survival.
authors.affiliation: Department of Abdominal Surgery, Hospital A. C. Camargo, São Paulo, Brazil.
authors.forename: Leonardo J
authors.initials: LJ
authors.lastname: Valadares
authors.affiliation: Department of Abdominal Surgery, Hospital A. C. Camargo, São Paulo, Brazil.
authors.forename: Wilson
authors.initials: W
authors.lastname: Costa Junior
authors.affiliation: Department of Abdominal Surgery, Hospital A. C. Camargo, São Paulo, Brazil.
authors.forename: Heber Salvador C
authors.initials: HS
authors.lastname: Ribeiro
authors.affiliation: Department of Abdominal Surgery, Hospital A. C. Camargo, São Paulo, Brazil.
authors.forename: Alessandro L
authors.initials: AL
authors.lastname: Diniz
authors.affiliation: Department of Abdominal Surgery, Hospital A. C. Camargo, São Paulo, Brazil.
authors.forename: Felipe J F
authors.initials: FJ
authors.lastname: Coimbra
authors.affiliation: Department of Gastroenterology, Faculty of Medicine, Universidade de São Paulo, São Paulo, Brazil.
authors.forename: Paulo
authors.initials: P
authors.lastname: Herman
mesh_terms: D000328:Adult; D000368:Aged; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality / Q000556:secondary* / Q000601:surgery*; D008297:Male; D059146:Metastasectomy; D008875:Middle Aged; D018358:Neuroendocrine Tumors / Q000401:mortality / Q000556:secondary* / Q000601:surgery*; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome