Liver-directed surgery of neuroendocrine metastases: What is the optimal strategy?
JE Maxwell, SK Sherman, TM O'Dorisio, AM Bellizzi…�- Surgery, 2016 - Elsevier
JE Maxwell, SK Sherman, TM O'Dorisio, AM Bellizzi, JR Howe
Surgery, 2016•ElsevierIntroduction 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. Methods Clinicopathologic�…
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. Methods Clinicopathologic�…
Introduction
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.
Methods
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.
Results
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).
Conclusion
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.
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