Xu-Feng Zhang1,2, Eliza W Beal2, Matthew Weiss3, Luca Aldrighetti4, George A Poultsides5, Todd W Bauer6, Ryan C Fields7, Shishir K Maithel8, Hugo P Marques9, Timothy M Pawlik2. 1. Department of Hepatobiliary Surgery and Institute of Advanced Surgical Technology and Engineering, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China. 2. Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio. 3. Department of Surgery, Johns Hopkins Hospital, Baltimore, Maryland. 4. Department of Surgery, Scientific Institute San Raffaele, Vita-Salute San Raffaele University, Milan, Italy. 5. Department of Surgery, Stanford University, Stanford, California. 6. Department of Surgery, University of Virginia, Charlottesville, Virginia. 7. Department of Surgery, Washington University, School of Medicine, St Louis, Missouri. 8. Department of Surgery, Emory University, Atlanta, Georgia. 9. Department of Surgery, Curry Cabral Hospital, Lisbon, Portugal.
Abstract
BACKGROUND AND OBJECTIVES: The objective of the study was to evaluate the impact of timing of disease occurrence and hepatic resection on long-term outcome of neuroendocrine liver metastasis (NELM). METHODS: A total of 420 patients undergoing curative-intent resection for NELM were identified from a multi-institutional database. Date of primary resection, NELM detection and resection, intraoperative details, disease-specific (DSS), and recurrence-free survival (RFS) were obtained. RESULTS: A total of 243 (57.9%) patients had synchronous NELM, while 177 (42.1%) developed metachronous NELM. On propensity score matching (PSM), patients with synchronous versus metachronous NELM had comparable DSS (10-year DSS, 76.2% vs 85.9%, P = 0.105), yet a worse RFS (10-year RFS, 34.1% vs 59.8%, P = 0.008). DSS and RFS were comparable regardless of operative approach (simultaneous vs staged, both P > 0.1). Among patients who developed metachronous NELM, no difference in long-term outcomes were identified between early (≤2 years, n = 102, 57.6%) and late (>2 years, n = 68, 42.4%) disease on PSM (both P > 0.1). CONCLUSIONS: Patients with synchronous NELM had a higher risk of tumor recurrence after hepatic resection versus patients with metachronous disease. The time to development of metachronous NELM did not affect long-term outcome. Curative-intent hepatic resection should be considered for patients who develop NELM regardless of the timing of disease presentation.
BACKGROUND AND OBJECTIVES: The objective of the study was to evaluate the impact of timing of disease occurrence and hepatic resection on long-term outcome of neuroendocrine liver metastasis (NELM). METHODS: A total of 420 patients undergoing curative-intent resection for NELM were identified from a multi-institutional database. Date of primary resection, NELM detection and resection, intraoperative details, disease-specific (DSS), and recurrence-free survival (RFS) were obtained. RESULTS: A total of 243 (57.9%) patients had synchronous NELM, while 177 (42.1%) developed metachronous NELM. On propensity score matching (PSM), patients with synchronous versus metachronous NELM had comparable DSS (10-year DSS, 76.2% vs 85.9%, P = 0.105), yet a worse RFS (10-year RFS, 34.1% vs 59.8%, P = 0.008). DSS and RFS were comparable regardless of operative approach (simultaneous vs staged, both P > 0.1). Among patients who developed metachronous NELM, no difference in long-term outcomes were identified between early (≤2 years, n = 102, 57.6%) and late (>2 years, n = 68, 42.4%) disease on PSM (both P > 0.1). CONCLUSIONS:Patients with synchronous NELM had a higher risk of tumor recurrence after hepatic resection versus patients with metachronous disease. The time to development of metachronous NELM did not affect long-term outcome. Curative-intent hepatic resection should be considered for patients who develop NELM regardless of the timing of disease presentation.
Authors: Jordan M Cloyd; Aslam Ejaz; Bhavana Konda; Mina S Makary; Timothy M Pawlik Journal: Hepatobiliary Surg Nutr Date: 2020-08 Impact factor: 7.293