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Surgical Management of Hepatic Neuroendocrine Tumor Metastasis: Results from an International Multi-Institutional Analysis

  • Hepatobiliary Tumors
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Management of neuroendocrine tumor liver metastasis (NELM) remains controversial, with some advocating an aggressive surgical approach while others have adopted a more conservative strategy. We sought to define the efficacy of the surgical management of NELM in a large multicenter international cohort of patients.

Methods

We identified 339 patients who underwent surgical management for NELM from 1985 to 2009 from an international database of eight major hepatobiliary centers. Relevant clinicopathologic data were assessed using Kaplan–Meier and Cox regression models.

Results

Most patients had a pancreatic (40%) or small bowel (25%) neuroendocrine tumor (NET) primary. The majority of patients (60%) had bilateral liver disease. At surgery, 78% of patients underwent hepatic resection, 3% ablation alone, and 19% resection + ablation. Major hepatectomy was performed in 45% of patients, and 14% underwent a second liver operation. Carcinoid was the most common NET histological subtype (53%). Median survival was 125 months, with overall 5- and 10-year survival of 74%, and 51%, respectively. Disease recurred in 94% of patients at 5 years. Patients with hormonally functional NET who had R0/R1 resection benefited the most from surgery (P = 0.01). On multivariate analyses, synchronous disease [hazard ratio (HR) = 1.9], nonfunctional NET hormonal status (HR = 2.0), and extrahepatic disease (HR = 3.0) remained predictive of worse survival (all P < 0.05).

Conclusions

Liver-directed surgery for NELM is associated with prolonged survival; however, the majority of patients will develop recurrent disease. Patients with hormonally functional hepatic metastasis without prior extrahepatic or synchronous disease derive the greatest survival benefit from surgical management.

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Disclosures

Dr. Pawlik has served as a consultant to Bayer-Onyx. Dr. Choti is the Johns Hopkins University institutional principal investigator for clinical trials sponsored by Ipsen Corporation.

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Authors and Affiliations

  1. Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Skye C. Mayo MD, MPH, Mechteld C. de Jong MD, Richard D. Schulick MD, Michael A. Choti MD & Timothy M. Pawlik MD, MPH

  2. Ospedale San Raffaele, Milan, Italy

    Carlo Pulitano MD & Luca Aldrighetti MD

  3. Duke Medical Center, Durham, NC, USA

    Brian M. Clary MD & Srinevas K. Reddy MD

  4. University of Pittsburgh, Pittsburgh, PA, USA

    T. Clark Gamblin MD, MS & Scott A. Celinksi MD

  5. Emory University School of Medicine, Atlanta, GA, USA

    David A. Kooby MD, Charles A. Staley MD & Carrie K. Chu MD

  6. Hôpitaux Universitaires de Genève, Geneva, Switzerland

    Giles Mentha MD & Jennifer Strub MD

  7. University of Virginia, Charlottesville, VA, USA

    Jayme B. Stokes MD, Todd W. Bauer MD & Reid B. Adams MD

  8. Ospedale Mauriziano Umberto I, Turin, Italy

    Alessandro Ferrero MD & Lorenzo Capussotti MD

Authors
  1. Skye C. Mayo MD, MPH
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  2. Mechteld C. de Jong MD
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  3. Carlo Pulitano MD
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  4. Brian M. Clary MD
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  5. Srinevas K. Reddy MD
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  6. T. Clark Gamblin MD, MS
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  7. Scott A. Celinksi MD
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  9. Charles A. Staley MD
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  10. Jayme B. Stokes MD
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  11. Carrie K. Chu MD
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  12. Alessandro Ferrero MD
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  13. Richard D. Schulick MD
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  14. Michael A. Choti MD
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  15. Giles Mentha MD
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  16. Jennifer Strub MD
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  17. Todd W. Bauer MD
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  18. Reid B. Adams MD
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  19. Luca Aldrighetti MD
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  20. Lorenzo Capussotti MD
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  21. Timothy M. Pawlik MD, MPH
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Corresponding author

Correspondence to Timothy M. Pawlik MD, MPH.

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Mayo, S.C., de Jong, M.C., Pulitano, C. et al. Surgical Management of Hepatic Neuroendocrine Tumor Metastasis: Results from an International Multi-Institutional Analysis. Ann Surg Oncol 17, 3129–3136 (2010). https://doi.org/10.1245/s10434-010-1154-5

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  • DOI: https://doi.org/10.1245/s10434-010-1154-5

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