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

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• 作者：Skye C. Mayo MD ; MPH (1)
  Mechteld C. de Jong MD (1)
  Carlo Pulitano MD (2)
  Brian M. Clary MD (3)
  Srinevas K. Reddy MD (3)
  T. Clark Gamblin MD ; MS (4)
  Scott A. Celinksi MD (4)
  David A. Kooby MD (5)
  Charles A. Staley MD (5)
  Jayme B. Stokes MD (7)
  Carrie K. Chu MD (5)
  Alessandro Ferrero MD (8)
  Richard D. Schulick MD (1)
  Michael A. Choti MD (1)
  Giles Mentha MD (6)
  Jennifer Strub MD (6)
  Todd W. Bauer MD (7)
  Reid B. Adams MD (7)
  Luca Aldrighetti MD (2)
  Lorenzo Capussotti MD (8)
  Timothy M. Pawlik MD ; MPH (1)
  
• 刊名：Annals of Surgical Oncology
• 出版年：2010
• 出版时间：December 2010
• 年：2010
• 卷：17
• 期：12
• 页码：3129-3136
• 全文大小：289KB
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• 作者单位：Skye C. Mayo MD, MPH (1)
  Mechteld C. de Jong MD (1)
  Carlo Pulitano MD (2)
  Brian M. Clary MD (3)
  Srinevas K. Reddy MD (3)
  T. Clark Gamblin MD, MS (4)
  Scott A. Celinksi MD (4)
  David A. Kooby MD (5)
  Charles A. Staley MD (5)
  Jayme B. Stokes MD (7)
  Carrie K. Chu MD (5)
  Alessandro Ferrero MD (8)
  Richard D. Schulick MD (1)
  Michael A. Choti MD (1)
  Giles Mentha MD (6)
  Jennifer Strub MD (6)
  Todd W. Bauer MD (7)
  Reid B. Adams MD (7)
  Luca Aldrighetti MD (2)
  Lorenzo Capussotti MD (8)
  Timothy M. Pawlik MD, MPH (1)
  
  1. Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
  2. Ospedale San Raffaele, Milan, Italy
  3. Duke Medical Center, Durham, NC, USA
  4. University of Pittsburgh, Pittsburgh, PA, USA
  5. Emory University School of Medicine, Atlanta, GA, USA
  7. University of Virginia, Charlottesville, VA, USA
  8. Ospedale Mauriziano Umberto I, Turin, Italy
  6. H?pitaux Universitaires de Genève, Geneva, Switzerland
  

文摘

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.