Liver-directed surgery of neuroendocrine metastases: What is the optimal strategy?

Jessica E Maxwell; Scott K Sherman; Thomas M O'Dorisio; Andrew M Bellizzi; James R Howe

doi:10.1016/j.surg.2015.05.040

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Liver-directed surgery of neuroendocrine metastases: What is the optimal strategy?

Journal article

Peer reviewed

Liver-directed surgery of neuroendocrine metastases: What is the optimal strategy?

Jessica E Maxwell, Scott K Sherman, Thomas M O'Dorisio, Andrew M Bellizzi and James R Howe

Surgery, Vol.159(1), pp.320-335

01/2016

DOI: 10.1016/j.surg.2015.05.040

PMCID: PMC4688152

PMID: 26454679

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https://www.ncbi.nlm.nih.gov/pmc/articles/4688152View

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Abstract

Neuroendocrine tumors (NETs) frequently metastasize to the liver. Operative debulking offers symptomatic relief and improved survival; however, the frequent presence of multifocal, bilobar disease and high recurrence rates introduces doubt regarding their optimal management. Parenchyma-sparing debulking (PSD) procedures (ablation, enucleation, wedge resections) may offer similar survival improvements as resection while minimizing morbidity and preserving functional liver tissue. Clinicopathologic variables from 228 patients with small bowel or pancreatic NETs managed operatively at one institution were collected. Liver-directed surgery was carried out when substantial debulking was deemed feasible. Survival was assessed by use of the Kaplan-Meier method. A total of 108 patients with pancreatic NET or small bowel NET underwent liver-directed surgery with primarily PSD procedures. Nearly two-thirds of patients achieved 70% cytoreduction and 84% had concurrent resection of their primary. The median number of lesions treated was 6 (range, 1-36). There were no 30-day operative mortalities. The 30-day major complication rate was 13.0%. Patients who achieved 70% cytoreduction enjoyed improved progression free (median 3.2 years) and overall survival (median not reached). PSD procedures are safe and can achieve significant cytoreduction, which is associated with improved survival. Lowering the debulking target threshold to 70% may benefit NET patients by increasing eligibility for cytoreduction.

Neuroendocrine Tumors - pathology

Intestinal Neoplasms - surgery

Hepatectomy - methods

Humans

Middle Aged

Pancreatic Neoplasms - pathology

Pancreatic Neoplasms - surgery

Catheter Ablation

Liver Neoplasms - surgery

Male

Tumor Burden

Cytoreduction Surgical Procedures

Intestinal Neoplasms - pathology

Young Adult

Intestine, Small - surgery

Aged, 80 and over

Adult

Female

Neuroendocrine Tumors - surgery

Aged

Retrospective Studies

Liver - surgery

Liver Neoplasms - secondary

Details

Title: Subtitle: Liver-directed surgery of neuroendocrine metastases: What is the optimal strategy?
Creators: Jessica E Maxwell - Department of General Surgery, University of Iowa Carver College of Medicine, Iowa City, IA
Scott K Sherman - Department of General Surgery, University of Iowa Carver College of Medicine, Iowa City, IA
Thomas M O'Dorisio - Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA
Andrew M Bellizzi - Department of Pathology, University of Iowa Carver College of Medicine, Iowa City, IA
James R Howe - Department of General Surgery, University of Iowa Carver College of Medicine, Iowa City, IA. Electronic address: james-howe@uiowa.edu
Resource Type: Journal article
Publication Details: Surgery, Vol.159(1), pp.320-335
DOI: 10.1016/j.surg.2015.05.040
PMID: 26454679
PMCID: PMC4688152
NLM abbreviation: Surgery
ISSN: 0039-6060
eISSN: 1532-7361
Publisher: United States
Grant note: 5T32#CA148062-05 / NCI NIH HHS T32 CA148062 / NCI NIH HHS P30 CA086862 / NCI NIH HHS P50 CA174521 / NCI NIH HHS
Language: English
Date published: 01/2016
Academic Unit: Pathology; Surgery; Endocrinology and Metabolism; Internal Medicine
Record Identifier: 9984047850202771

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