Surgical management of hepatic neuroendocrine tumor metastasis: Results from an international multi-institutional analysis

Skye C. Mayo, Mechteld C. De Jong, Carlo Pulitano, Brian M. Clary, Srinevas K. Reddy, T. Clark Gamblin, Scott A. Celinksi, David A. Kooby, Charles A. Staley, Jayme B. Stokes, Carrie K. Chu, Alessandro Ferrero, Richard D. Schulick, Michael A. Choti, Giles Mentha, Jennifer Strub, Todd W. Bauer, Reid B. Adams, Luca Aldrighetti, Lorenzo CapussottiTimothy M. Pawlik

Research output: Contribution to journalArticle

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.

Original languageEnglish (US)
Pages (from-to)3129-3136
Number of pages8
JournalAnnals of Surgical Oncology
Volume17
Issue number12
DOIs
StatePublished - Dec 2010

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Neuroendocrine Tumors
Neoplasm Metastasis
Liver
Survival
Carcinoid Tumor
Hepatectomy
Proportional Hazards Models
Liver Diseases
Multivariate Analysis
Databases

ASJC Scopus subject areas

  • Surgery
  • Oncology

Cite this

Mayo, S. C., De Jong, M. C., Pulitano, C., Clary, B. M., Reddy, S. K., Gamblin, T. C., ... Pawlik, T. M. (2010). Surgical management of hepatic neuroendocrine tumor metastasis: Results from an international multi-institutional analysis. Annals of Surgical Oncology, 17(12), 3129-3136. https://doi.org/10.1245/s10434-010-1154-5

Surgical management of hepatic neuroendocrine tumor metastasis : Results from an international multi-institutional analysis. / Mayo, Skye C.; De Jong, Mechteld C.; Pulitano, Carlo; Clary, Brian M.; Reddy, Srinevas K.; Gamblin, T. Clark; Celinksi, Scott A.; Kooby, David A.; Staley, Charles A.; Stokes, Jayme B.; Chu, Carrie K.; Ferrero, Alessandro; Schulick, Richard D.; Choti, Michael A.; Mentha, Giles; Strub, Jennifer; Bauer, Todd W.; Adams, Reid B.; Aldrighetti, Luca; Capussotti, Lorenzo; Pawlik, Timothy M.

In: Annals of Surgical Oncology, Vol. 17, No. 12, 12.2010, p. 3129-3136.

Research output: Contribution to journalArticle

Mayo, SC, De Jong, MC, Pulitano, C, Clary, BM, Reddy, SK, Gamblin, TC, Celinksi, SA, Kooby, DA, Staley, CA, Stokes, JB, Chu, CK, Ferrero, A, Schulick, RD, Choti, MA, Mentha, G, Strub, J, Bauer, TW, Adams, RB, Aldrighetti, L, Capussotti, L & Pawlik, TM 2010, 'Surgical management of hepatic neuroendocrine tumor metastasis: Results from an international multi-institutional analysis', Annals of Surgical Oncology, vol. 17, no. 12, pp. 3129-3136. https://doi.org/10.1245/s10434-010-1154-5
Mayo, Skye C. ; De Jong, Mechteld C. ; Pulitano, Carlo ; Clary, Brian M. ; Reddy, Srinevas K. ; Gamblin, T. Clark ; Celinksi, Scott A. ; Kooby, David A. ; Staley, Charles A. ; Stokes, Jayme B. ; Chu, Carrie K. ; Ferrero, Alessandro ; Schulick, Richard D. ; Choti, Michael A. ; Mentha, Giles ; Strub, Jennifer ; Bauer, Todd W. ; Adams, Reid B. ; Aldrighetti, Luca ; Capussotti, Lorenzo ; Pawlik, Timothy M. / Surgical management of hepatic neuroendocrine tumor metastasis : Results from an international multi-institutional analysis. In: Annals of Surgical Oncology. 2010 ; Vol. 17, No. 12. pp. 3129-3136.
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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.",
author = "Mayo, {Skye C.} and {De Jong}, {Mechteld C.} and Carlo Pulitano and Clary, {Brian M.} and Reddy, {Srinevas K.} and Gamblin, {T. Clark} and Celinksi, {Scott A.} and Kooby, {David A.} and Staley, {Charles A.} and Stokes, {Jayme B.} and Chu, {Carrie K.} and Alessandro Ferrero and Schulick, {Richard D.} and Choti, {Michael A.} and Giles Mentha and Jennifer Strub and Bauer, {Todd W.} and Adams, {Reid B.} and Luca Aldrighetti and Lorenzo Capussotti and Pawlik, {Timothy M.}",
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T1 - Surgical management of hepatic neuroendocrine tumor metastasis

T2 - Results from an international multi-institutional analysis

AU - Mayo, Skye C.

AU - De Jong, Mechteld C.

AU - Pulitano, Carlo

AU - Clary, Brian M.

AU - Reddy, Srinevas K.

AU - Gamblin, T. Clark

AU - Celinksi, Scott A.

AU - Kooby, David A.

AU - Staley, Charles A.

AU - Stokes, Jayme B.

AU - Chu, Carrie K.

AU - Ferrero, Alessandro

AU - Schulick, Richard D.

AU - Choti, Michael A.

AU - Mentha, Giles

AU - Strub, Jennifer

AU - Bauer, Todd W.

AU - Adams, Reid B.

AU - Aldrighetti, Luca

AU - Capussotti, Lorenzo

AU - Pawlik, Timothy M.

PY - 2010/12

Y1 - 2010/12

N2 - 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.

AB - 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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