Effective cytoreduction can be achieved in patients with numerous neuroendocrine tumor liver metastases (NETLMs)

Aaron T Scott; Patrick J Breheny; Kendall J Keck; Andrew M Bellizzi; Joseph S Dillon; Thomas M O'Dorisio; James R Howe

doi:10.1016/j.surg.2018.04.070

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Effective cytoreduction can be achieved in patients with numerous neuroendocrine tumor liver metastases (NETLMs)

Journal article

Open access

Peer reviewed

Effective cytoreduction can be achieved in patients with numerous neuroendocrine tumor liver metastases (NETLMs)

Aaron T Scott, Patrick J Breheny, Kendall J Keck, Andrew M Bellizzi, Joseph S Dillon, Thomas M O'Dorisio and James R Howe

Surgery, Vol.165(1), pp.166-175

01/2019

DOI: 10.1016/j.surg.2018.04.070

PMCID: PMC6637412

PMID: 30343949

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https://www.ncbi.nlm.nih.gov/pmc/articles/6637412View

Open Access

Abstract

Cytoreductive surgery for neuroendocrine tumor liver metastases improves survival and symptomatic control. However, the feasibility of adequate cytoreduction in patients with many liver metastases remains uncertain. We compared patient outcomes based on the number of lesions treated to better define the efficacy of cytoreductive surgery for numerous neuroendocrine tumor liver metastases. Patients undergoing hepatic cytoreductive surgery for gastroenteropancreatic neuroendocrine tumors were identified in our institutional surgical neuroendocrine tumor database. Imaging studies were reviewed to determine the liver tumor burden and percent cytoreduced. Overall survival and progression-free survival were compared, using the number of lesions treated, percent tumor debulked, and additional clinicopathologic characteristics. A total of 188 hepatic cytoreductive procedures were identified and stratified into groups according to the number of metastases treated: 1-5, 6-10, and >10. Median overall survival and progression-free survival were 89.4 and 22.5 months, respectively, and did not differ significantly between groups. Greater than 70% cytoreduction was associated with significantly better overall survival than <70% cytoreduction (134 months versus 38 months). In patients with gastroenteropancreatic neuroendocrine tumors and liver metastases, >70% cytoreduction led to improved overall survival and progression-free survival and was achieved reliably in patients undergoing debulking of >10 lesions. These data support an aggressive approach to patients with numerous neuroendocrine tumor liver metastases to achieve >70% cytoreduction.

Neuroendocrine Tumors - pathology

Intestinal Neoplasms - surgery

Intestinal Neoplasms - mortality

Age Factors

Humans

Middle Aged

Pancreatic Neoplasms - pathology

Pancreatic Neoplasms - surgery

Liver Neoplasms - surgery

Male

Stomach Neoplasms - pathology

Liver Neoplasms - mortality

Cytoreduction Surgical Procedures

Intestinal Neoplasms - pathology

Progression-Free Survival

Neuroendocrine Tumors - mortality

Female

Neuroendocrine Tumors - surgery

Pancreatic Neoplasms - mortality

Retrospective Studies

Liver Neoplasms - secondary

Stomach Neoplasms - surgery

Postoperative Complications

Stomach Neoplasms - mortality

Details

Title: Subtitle: Effective cytoreduction can be achieved in patients with numerous neuroendocrine tumor liver metastases (NETLMs)
Creators: Aaron T Scott - Department of Surgery, University of Iowa Carver College of Medicine, Iowa City
Patrick J Breheny - Department of Biostatistics, University of Iowa College of Public Health, Iowa City
Kendall J Keck - Department of Surgery, University of Iowa Carver College of Medicine, Iowa City
Andrew M Bellizzi - Department of Pathology, University of Iowa Carver College of Medicine, Iowa City
Joseph S Dillon - Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City
Thomas M O'Dorisio - Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City
James R Howe - Department of Surgery, University of Iowa Carver College of Medicine, Iowa City. Electronic address: james-howe@uiowa.edu
Resource Type: Journal article
Publication Details: Surgery, Vol.165(1), pp.166-175
DOI: 10.1016/j.surg.2018.04.070
PMID: 30343949
PMCID: PMC6637412
NLM abbreviation: Surgery
ISSN: 0039-6060
eISSN: 1532-7361
Publisher: United States
Grant note: P30 CA086862 / NCI NIH HHS T32 CA148062 / NCI NIH HHS P50 CA174521 / NCI NIH HHS
Language: English
Date published: 01/2019
Academic Unit: Pathology; Biostatistics; Surgery; Fraternal Order of Eagles Diabetes Research Center; Endocrinology and Metabolism; Internal Medicine
Record Identifier: 9984047767902771

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