The Impact of Extent of Liver Resection Among Patients with Neuroendocrine Liver Metastasis: an International Multi-institutional Study

Sham, Jonathan G.; Ejaz, Aslam; Gage, Michele M.; Bagante, Fabio; Reames, Bradley N.; Maithel, Shishir K.; Poultsides, George A.; Bauer, Todd W.; Fields, Ryan C.; Weiss, Matthew J.; Aldrighetti, Luca; Pawlik, Timothy M.; He, Jin

doi:10.1007/s11605-018-3862-2

Cited by 14 publications

(7 citation statements)

References 16 publications

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“…17 There is precedent for metastasectomy in different neoplasms, especially for liver metastases from colorectal or pancreatic neuroendocrine cancer. 36,37 However, recurrent PDAC is particularly difficult to manage surgically, as it typically is characterized by multifocal and destructive spread. Therefore, pulmonary metastasectomy remains a non-standard and individual treatment approach, for which appropriate selection of patients with favorable tumor biology is paramount.…”

Section: Discussionmentioning

confidence: 99%

Isolated pulmonary recurrence after resection of pancreatic cancer: the effect of patient factors and treatment modalities on survival

Groot

Blair

Gemenetzis

et al. 2019

HPB

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Background: The literature suggests favorable survival for patients with isolated pulmonary recurrence after resection of pancreatic ductal adenocarcinoma (PDAC) as compared to other recurrence patterns. Within this cohort, it remains unclear what factors are associated with improved survival. Methods: Patients who developed pulmonary recurrence after pancreatectomy were selected from a prospective database. Predictors for post-recurrence survival (PRS) were analyzed using a multivariable Cox regression model. Results: Ninety-six patients were included. Median recurrence-free survival (RFS), PRS and overall survival (OS) were 16.3, 18.8 and 39.6 months, respectively. Further systemic treatment and/or metastasectomy (n = 64, 67%) was associated with significantly improved PRS and OS when compared to best supportive care (n = 35, 22%) (26.3 vs. 5.3 and 48.1 vs. 18.4, respectively; both P < 0.001). Patients who were able to undergo metastasectomy (n = 19) achieved a PRS and OS of 35.0 and 68.9 months, respectively. More than 5 pulmonary lesions, symptoms and CA 19-9 100 U/mL at time of recurrence were predictive of decreased PRS. A recurrence-free interval of >16 months and treatment for recurrence were independently associated with improved PRS. Conclusions: Isolated pulmonary recurrence occurs in 13% of patients with recurrent PDAC and is associated with a median OS of 40 months. Aggressive treatment in highly selected patients was correlated with improved survival.

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Section: Discussionmentioning

confidence: 99%

Isolated pulmonary recurrence after resection of pancreatic cancer: the effect of patient factors and treatment modalities on survival

Groot

Blair

Gemenetzis

et al. 2019

HPB

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“…113,[118][119][120][121] Non-anatomic resection may be associated with a higher incidence of recurrence than formal anatomic hepatectomy, but has a similar impact on OS. 122 Surgical cytoreduction. For unresectable NET liver metastases, surgical cytoreduction can be considered.…”

Section: Surgical Management Of Liver Metastasismentioning

confidence: 99%

Management of Gastrointestinal Neuroendocrine Tumors

Wang

Zheng-Pywell

Chen

et al. 2019

Clin Med Insights Endocrinol Diabetes

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Neuroendocrine neoplasms (NENs) are derived from neuroendocrine cell system and can have benign or malignant characteristics. They are rare tumors, but have been increasing in incidence over the past 40 years. Patients with NENs may develop symptoms due to primary tumor invasion, metastasis, or from secretion of hormonally active tumor substances. Multiple imaging modalities are used for diagnosis and staging, including specialty scans such as 111In pentetreotide (Octreoscan) and 68Gallium-DOTATATE, along with endoscopy, endoscopic ultrasound, and biochemical marker testing. Treatment involves both surgical approach, for both primary and metastatic lesions, as well as medical management for symptom management and disease progression. This article will review the current clinical knowledge regarding the diagnosis, treatment, and prognosis of these fascinating neoplasms and the associated hormonal syndromes.

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“…The benefit of surgical therapy of liver metastasis is discussed controversially. A recent analysis showed that the type of liver resection (anatomic versus non-anatomic) in patients with M1 disease showed higher rates of recurrence after non-anatomic resection but the type of resection did not affect overall survival [8]. Another analysis of 111 patients found that surgical resection influenced mortality after 5 but not after 10 years [9].…”

Section: Introductionmentioning

confidence: 99%

Neuroendocrine liver metastasis from the small intestine: Is surgery beneficial for survival?

Selberherr

Freermann

Koperek

et al. 2021

Orphanet J Rare Dis

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Background Neuroendocrine neoplasia of the small intestine (siNEN) are frequently diagnosed with liver metastases. The impact of the presence of liver metastases on overall survival and the necessity of surgery for liver metastasis is discussed controversially. The aim of this study is to evaluate and compare the overall long-term survival of patients with siNENs with and without liver metastasis at initial diagnosis and the possible benefit of surgical treatment as compared to active surveillance of metastases. 123 consecutive patients with siNENs were treated between 1965 and 2016. All clinical and histological records were reevaluated including analysis of the proliferation rates in all specimens. The 1-, 5-, 10- and 20-year overall survival was estimated by Kaplan–Meier analysis for patients with and without liver metastasis and according to the type of treatment (surgical vs. surveillance) of liver metastases if present. Results The 1-, 5-, 10- and 20-year overall survival rate was 89.0%, 68.4%, 52.8% and 31.0% in patients without and 89.5%, 69.5%, 33.2% and 3.6% in those with liver metastases. No statistically significant differences were observed comparing the two groups. Within the group of patients with liver metastases, the type of treatment (surgical vs. surveillance) was in favor of patients undergoing surgery. Multivariate analysis showed that the presence of liver metastases upon diagnosis was an individual risk factor associated with worse survival. Conclusion The presence of liver metastasis at initial diagnosis does not have a statistically significant influence on survival. Surgery for hepatic metastasis seems to show a benefit for overall survival and may be indicated especially in patients symptomatic due to high tumor burden and serotonin hypersecretion to reduce hormone activity.

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The Impact of Extent of Liver Resection Among Patients with Neuroendocrine Liver Metastasis: an International Multi-institutional Study

Abstract: NAR was independently associated with a higher incidence of recurrence versus patients who undergo a formal anatomic hepatectomy among patients with NELM.

Cited by 14 publications

References 16 publications

Isolated pulmonary recurrence after resection of pancreatic cancer: the effect of patient factors and treatment modalities on survival

Isolated pulmonary recurrence after resection of pancreatic cancer: the effect of patient factors and treatment modalities on survival

Management of Gastrointestinal Neuroendocrine Tumors

Neuroendocrine liver metastasis from the small intestine: Is surgery beneficial for survival?

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