BACKGROUND: Surgical extirpation of neuroendocrine neoplasms hepatic metastases (NENHM) provides the best opportunity of long-term survival but is not feasible in the majority of patients given the widespread presentation of liver disease. Combining resection with local ablation can potentially expand the resection criteria and thereby improve survival. The present study critically evaluates the progression-free survival (PFS) and overall survival (OS) of patients with NENHM who underwent concomitant hepatic resection and cryoablation. METHODS: Forty patients with NENHM underwent concomitant hepatic resection and cryoablation between December 1992 and June 2010. PFS and OS were determined; clinicopathologic and treatment-related factors associated with PFS and OS were evaluated through univariate and multivariate analyses. RESULTS: The median follow-up for the patients who were alive was 61 months (range, 1 to 162 mo). The median PFS and OS after hepatic resection were 22 and 95 months, respectively. Five-year and 10-year OS rate was 61% and 40%, respectively. One independent factor was associated with OS: histologic grade (P=0.001). One independent factor was associated with PFS: extrahepatic disease (P=0.003). CONCLUSION: Concomitant hepatic resection and cryoablation to achieve tumor debulking is associated with excellent survival outcomes in selected patients. This approach may increase the number of patients with borderline resectable disease undergoing surgical management of advanced NENHM.
BACKGROUND: Surgical extirpation of neuroendocrine neoplasms hepatic metastases (NENHM) provides the best opportunity of long-term survival but is not feasible in the majority of patients given the widespread presentation of liver disease. Combining resection with local ablation can potentially expand the resection criteria and thereby improve survival. The present study critically evaluates the progression-free survival (PFS) and overall survival (OS) of patients with NENHM who underwent concomitant hepatic resection and cryoablation. METHODS: Forty patients with NENHM underwent concomitant hepatic resection and cryoablation between December 1992 and June 2010. PFS and OS were determined; clinicopathologic and treatment-related factors associated with PFS and OS were evaluated through univariate and multivariate analyses. RESULTS: The median follow-up for the patients who were alive was 61 months (range, 1 to 162 mo). The median PFS and OS after hepatic resection were 22 and 95 months, respectively. Five-year and 10-year OS rate was 61% and 40%, respectively. One independent factor was associated with OS: histologic grade (P=0.001). One independent factor was associated with PFS: extrahepatic disease (P=0.003). CONCLUSION: Concomitant hepatic resection and cryoablation to achieve tumor debulking is associated with excellent survival outcomes in selected patients. This approach may increase the number of patients with borderline resectable disease undergoing surgical management of advanced NENHM.
Authors: Alexander V Fisher; Alexandra G Lopez-Aguiar; Victoria R Rendell; Courtney Pokrzywa; Flavio G Rocha; Zaheer S Kanji; George A Poultsides; Eleftherios A Makris; Mary E Dillhoff; Eliza W Beal; Ryan C Fields; Roheena Z Panni; Kamran Idrees; Paula Marincola Smith; Clifford S Cho; Megan V Beems; Shishir K Maithel; Emily R Winslow; Daniel E Abbott; Sharon M Weber Journal: J Gastrointest Surg Date: 2019-01-18 Impact factor: 3.452
Authors: Vladimir Neychev; Seth M Steinberg; Candice Cottle-Delisle; Roxanne Merkel; Naris Nilubol; Jianhua Yao; Paul Meltzer; Karel Pacak; Stephen Marx; Electron Kebebew Journal: BMJ Open Date: 2015-05-19 Impact factor: 2.692