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01-07-2020 | Metastasis | Original Scientific Report

Outcomes of Simultaneous Resection of Small Bowel Neuroendocrine Tumors with Synchronous Liver Metastases

Authors: Pietro Addeo, Jean-Baptiste Bertin, Alessio Imperiale, Gerlinde Averous, Alfonso Terrone, Bernard Goichot, Philippe Bachellier

Published in: World Journal of Surgery | Issue 7/2020

Abstract

Background

This study evaluated the short- and long-term outcomes of synchronous resection of liver metastases (LM) from small bowel neuroendocrine tumors (SB-NET).

Methods

A retrospective review of patients undergoing resection for LMs from SB-NETs from January 1997 and December 2018 was performed.

Results

There were 44 patients with synchronous SB-NET and LMs. Perioperative and 90-day mortality values were zero, and the morbidity rate was 27%. The median overall survival (OS) was 128.4 months (CI 95% 74.0–161.5 months) with 1-, 3-, 5-, and 10-year survival rates of 100%, 83%, 79%, and 60%, respectively. Not achieving surgical treatment for LM was the unique independent factor for survival (HR 6.50; CI 95% 1.54–27.28; p = 0.01) in patients with unresected LMs having OS and 10-year survival rates (42 months, 33%) versus patients undergoing liver resection (152 months, 66%)(p = 0.0008). The recurrence rate was 81.8% and associated with longer OS and 5-year survival rates when limited to the liver [223 months (61%) vs 94 months (87%)].

Conclusions

Simultaneous resection of SB-NETs with synchronous LMs was safe and associated with considerable long-term survival even in the presence of bilobar disease. However, recurrence after resection was common (81%) but associated with longer survival rates when limited to the liver.

Fraenkel M, Kim MK, Faggiano A, Valk GD (2012) Epidemiology of gastroenteropancreatic neuroendocrine tumours. Best Pract Res Clin Gastroenterol 26:691–703CrossRef

Frilling A, Li J, Malamutmann E, Schmid KW, Bockisch A, Broelsch CE (2009) Treatment of liver metastases from neuroendocrine tumours in relation to the extent of hepatic disease. Br J Surg 96:175–184CrossRef

Fairweather M, Swanson R, Wang J et al (2017) Management of neuroendocrine tumor liver metastases: long-term outcomes and prognostic factors from a large prospective database. Ann Surg Oncol 24:2319–2325CrossRef

Bertani E, Falconi M, Grana C et al (2015) Small intestinal neuroendocrine tumors with liver metastases and resection of the primary: prognostic factors for decision making. Int J Surg 20:58–64CrossRef

Citterio D, Pusceddu S, Facciorusso A et al (2017) Primary tumour resection may improve survival in functional well-differentiated neuroendocrine tumours metastatic to the liver. Eur J Surg Oncol 43:380–387CrossRef

Maxwell JE, Sherman SK, O’Dorisio TM, Bellizzi AM, Howe JR (2016) Liver-directed surgery of neuroendocrine metastases: what is the optimal strategy? Surgery 159:320–333CrossRef

Graff-Baker AN, Sauer DA, Pommier SJ, Pommier RF (2014) Expanded criteria for carcinoid liver debulking: maintaining survival and increasing the number of eligible patients. Surgery 156:1369–1376 (discussion 76-7) CrossRef

Fisher AT, Titan AL, Foster DS et al (2019) Management of ileal neuroendocrine tumors with liver metastases. J Gastrointest Surg. https://doi.org/10.1007/s11605-019-04309-7. [Epub ahead of print]CrossRefPubMed

Norton JA, Warren RS, Kelly MG, Zuraek MB, Jensen RT (2003) Aggressive surgery for metastatic liver neuroendocrine tumors. Surgery 134:1057–1063 (discussion 63-5) CrossRef

10.

Ruzzenente A, Bagante F, Bertuzzo F et al (2017) A novel nomogram to predict the prognosis of patients undergoing liver resection for neuroendocrine liver metastasis: an analysis of the Italian neuroendocrine liver metastasis database. J Gastrointest Surg 21:41–48CrossRef

11.

Elias D, Lefevre JH, Duvillard P et al (2010) Hepatic metastases from neuroendocrine tumors with a “thin slice” pathological examination: they are many more than you think. Ann Surg 251:307–310CrossRef

12.

Norlen O, Stalberg P, Zedenius J, Hellman P (2013) Outcome after resection and radiofrequency ablation of liver metastases from small intestinal neuroendocrine tumours. Br J Surg 100:1505–1514CrossRef

13.

Addeo P, d’Alessandro A, Averous G et al (2019) Macrovascular venous invasion of pancreatic neuroendocrine tumours: impact on surgical outcomes and survival. HPB (Oxford) 21:653–661CrossRef

14.

Pasquer A, Walter T, Rousset P et al (2016) Lymphadenectomy during small bowel neuroendocrine tumor surgery: the concept of skip metastases. Ann Surg Oncol 23:804–808CrossRef

15.

Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213CrossRef

16.

Balzan S, Belghiti J, Farges O et al (2005) The “50-50 criteria” on postoperative day 5: an accurate predictor of liver failure and death after hepatectomy. Ann Surg 242:824–828 (discussion 8-9) CrossRef

17.

Narita M, Oussoultzoglou E, Fuchshuber P et al (2012) Prolonged portal triad clamping increases postoperative sepsis after major hepatectomy in patients with sinusoidal obstruction syndrome and/or steatohepatitis. World J Surg 36:1848–1857. https://doi.org/10.1007/s00268-012-1565-5 CrossRefPubMed

18.

Elias D, Goere D, Leroux G et al (2009) Combined liver surgery and RFA for patients with gastroenteropancreatic endocrine tumors presenting with more than 15 metastases to the liver. Eur J Surg Oncol 35:1092–1097CrossRef

19.

Gaujoux S, Gonen M, Tang L et al (2012) Synchronous resection of primary and liver metastases for neuroendocrine tumors. Ann Surg Oncol 19:4270–4277CrossRef

20.

Sarmiento JM, Heywood G, Rubin J, Ilstrup DM, Nagorney DM, Que FG (2003) Surgical treatment of neuroendocrine metastases to the liver: a plea for resection to increase survival. J Am Coll Surg 197:29–37CrossRef

Title: Outcomes of Simultaneous Resection of Small Bowel Neuroendocrine Tumors with Synchronous Liver Metastases
Authors: Pietro Addeo
Jean-Baptiste Bertin
Alessio Imperiale
Gerlinde Averous
Alfonso Terrone
Bernard Goichot
Philippe Bachellier
Publication date: 01-07-2020
Publisher: Springer International Publishing
Keywords: Metastasis
Liver Resection
Liver Resection
Neuroendocrine Tumor
Published in: World Journal of Surgery / Issue 7/2020
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI: https://doi.org/10.1007/s00268-020-05467-5

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Outcomes of Simultaneous Resection of Small Bowel Neuroendocrine Tumors with Synchronous Liver Metastases

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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