title: Long-Term Outcomes of Surgical Management of Pancreatic Neuroendocrine Tumors with Synchronous Liver Metastases.
abstract: BACKGROUND
  The value of surgical resection in the management of pancreatic neuroendocrine tumors (PNET) with liver metastases (LM) is still debated. The aim of this study was to evaluate the outcomes of surgery of PNET with LM.
  
  
  METHODS
  Patients with PNET with synchronous LM between 2000 and 2011 from 4 high-volume institutions were included. The patients were divided into 3 groups: curative resection, palliative resection, and no resection.
  
  
  RESULTS
  Overall, 166 patients were included. Eighteen patients (11%) underwent curative resection, 73 patients (43%) underwent palliative resection, and 75 patients (46%) underwent conservative treatment. The median overall survival (OS) from the time of diagnosis was 73 months. Patients who underwent curative resection had a significantly better median OS from the initial diagnosis compared with those who underwent palliative resection and those who were conservatively treated (97 vs. 89 vs. 36 months, p = 0.0001). The median OS from the time of diagnosis in those patients who underwent radical or palliative resection was 97 months, with a 5-year survival rate of 76%. On multivariate analysis, factors associated with OS from the time of diagnosis were the presence of bilobar metastases, tumor grading, and curative resection in a first model. On a second model, curative or palliative surgery was an independent predictor of OS. Among 91 patients who underwent surgery, the presence of pancreatic neuroendocrine carcinoma G3 was the only factor independently associated with a poorer survival after surgery (median OS: 35 vs. 97 months, p < 0.0001).
  
  
  CONCLUSIONS
  Patients with LM from PNET benefit from surgical resection, although surgery should be reserved to well- or moderately differentiated forms.
authors.affiliation: Pancreatic Surgery Unit, University Hospital of Ancona, Ancona, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Partelli
authors.forename: Marco
authors.initials: M
authors.lastname: Inama
authors.forename: Anja
authors.initials: A
authors.lastname: Rinke
authors.forename: Nehara
authors.initials: N
authors.lastname: Begum
authors.forename: Roberto
authors.initials: R
authors.lastname: Valente
authors.forename: Volker
authors.initials: V
authors.lastname: Fendrich
authors.forename: Domenico
authors.initials: D
authors.lastname: Tamburrino
authors.forename: Tobias
authors.initials: T
authors.lastname: Keck
authors.forename: Martyn E
authors.initials: ME
authors.lastname: Caplin
authors.forename: Detlef
authors.initials: D
authors.lastname: Bartsch
authors.forename: Christina
authors.initials: C
authors.lastname: Thirlwell
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Fusai
authors.forename: Massimo
authors.initials: M
authors.lastname: Falconi
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000401:mortality* / Q000556:secondary; D008297:Male; D008875:Middle Aged; D018358:Neuroendocrine Tumors / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D010166:Palliative Care; D010190:Pancreatic Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome