Jonathan G Sham1, Aslam Ejaz1, Michele M Gage1, Fabio Bagante2, Bradley N Reames1, Shishir Maithel3, George A Poultsides4, Todd W Bauer5, Ryan C Fields6, Matthew J Weiss1, Hugo Pinto Marques7, Luca Aldrighetti8, Timothy M Pawlik2, Jin He9. 1. Department of Surgery, The Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Halsted 614, Baltimore, MD, 21287, USA. 2. Division of Surgical Oncology, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA. 3. Department of Surgery, Emory University, Atlanta, GA, USA. 4. Department of Surgery, School of Medicine, Stanford University, Stanford, CA, USA. 5. Department of Surgery, University of Virginia, Charlottesville, VA, USA. 6. Department of Surgery, School of Medicine, Washington University, St. Louis, MO, USA. 7. Department of Surgery, Curry Cabral Hospital, Lisbon, Portugal. 8. Department of Surgery, Liver Unit, Scientific Institute San Raffaele, Vita-Salute San Raffaele University, Milan, Italy. 9. Department of Surgery, The Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Halsted 614, Baltimore, MD, 21287, USA. jhe11@jhmi.edu.
Abstract
BACKGROUND: Liver resection in patients with neuroendocrine liver metastasis (NELM) provides a survival benefit, yet the optimal extent of resection remains unknown. We sought to examine outcomes of patients undergoing non-anatomic (NAR) versus anatomic liver resection (AR) for NELM using a large international cohort of patients. METHODS: Two hundred and fifty-eight patients who underwent curative intent liver resection from January 1990 to December 2016 were identified from eight institutions. Patients were excluded if they underwent concurrent ablation, had extrahepatic disease, underwent a debulking operation, or had mixed anatomic and non-anatomic resections. Overall (OS) and recurrence-free (RFS) survival were compared among patients based on the extent of liver resection (AR vs. NAR). RESULTS: Most primary tumors were located in the pancreas (n = 117, 45.4%) or the small intestine (n = 65, 25.2%). Liver resection consisted of NAR (n = 126, 48.8%) or AR (n = 132, 51.2%) resection. The overwhelming majority of patients who underwent NAR had an estimated liver involvement of < 50% (NAR 109, 97.3% vs. AR n = 82, 65.6%; P < 0.001). Patients who underwent NAR also had higher rates of primary tumor lymph node metastasis (NAR n = 79, 71.2% vs. AR n = 37, 33.6%; P < 0.001) and microscopically positive margins (R1) (NAR n = 29, 25.7% vs. AR n = 16, 12.5%; P = 0.009). After a median follow-up of 47.7 months, 48 (18.6%) patients died and 37.0% (n = 95) had evidence of disease recurrence. Patients who underwent AR had both longer median OS (not reached) and RFS (not reached) versus patients who underwent NAR (median OS 138.3 months; median RFS 31.3 months) (both P < 0.01). After controlling for patient and disease-related factors, extent of liver resection was independently associated with an increased risk of recurrence (HR 2.39, 95% CI 1.04-5.48; P = 0.04) but not death (HR 1.92, 95% CI 0.40-9.28; P = 0.42). CONCLUSION: NAR was independently associated with a higher incidence of recurrence versus patients who undergo a formal anatomic hepatectomy among patients with NELM.
BACKGROUND: Liver resection in patients with neuroendocrine liver metastasis (NELM) provides a survival benefit, yet the optimal extent of resection remains unknown. We sought to examine outcomes of patients undergoing non-anatomic (NAR) versus anatomic liver resection (AR) for NELM using a large international cohort of patients. METHODS: Two hundred and fifty-eight patients who underwent curative intent liver resection from January 1990 to December 2016 were identified from eight institutions. Patients were excluded if they underwent concurrent ablation, had extrahepatic disease, underwent a debulking operation, or had mixed anatomic and non-anatomic resections. Overall (OS) and recurrence-free (RFS) survival were compared among patients based on the extent of liver resection (AR vs. NAR). RESULTS: Most primary tumors were located in the pancreas (n = 117, 45.4%) or the small intestine (n = 65, 25.2%). Liver resection consisted of NAR (n = 126, 48.8%) or AR (n = 132, 51.2%) resection. The overwhelming majority of patients who underwent NAR had an estimated liver involvement of < 50% (NAR 109, 97.3% vs. AR n = 82, 65.6%; P < 0.001). Patients who underwent NAR also had higher rates of primary tumor lymph node metastasis (NAR n = 79, 71.2% vs. AR n = 37, 33.6%; P < 0.001) and microscopically positive margins (R1) (NAR n = 29, 25.7% vs. AR n = 16, 12.5%; P = 0.009). After a median follow-up of 47.7 months, 48 (18.6%) patients died and 37.0% (n = 95) had evidence of disease recurrence. Patients who underwent AR had both longer median OS (not reached) and RFS (not reached) versus patients who underwent NAR (median OS 138.3 months; median RFS 31.3 months) (both P < 0.01). After controlling for patient and disease-related factors, extent of liver resection was independently associated with an increased risk of recurrence (HR 2.39, 95% CI 1.04-5.48; P = 0.04) but not death (HR 1.92, 95% CI 0.40-9.28; P = 0.42). CONCLUSION: NAR was independently associated with a higher incidence of recurrence versus patients who undergo a formal anatomic hepatectomy among patients with NELM.
Authors: Sandeepa Musunuru; Herbert Chen; Sharad Rajpal; Nicholas Stephani; John C McDermott; Kyle Holen; Layton F Rikkers; Sharon M Weber Journal: Arch Surg Date: 2006-10
Authors: Skye C Mayo; Mechteld C de Jong; Carlo Pulitano; Brian M Clary; Srinevas K Reddy; T Clark Gamblin; Scott A Celinksi; David A Kooby; Charles A Staley; Jayme B Stokes; Carrie K Chu; Alessandro Ferrero; Richard D Schulick; Michael A Choti; Giles Mentha; Jennifer Strub; Todd W Bauer; Reid B Adams; Luca Aldrighetti; Lorenzo Capussotti; Timothy M Pawlik Journal: Ann Surg Oncol Date: 2010-06-29 Impact factor: 5.344
Authors: John G Touzios; James M Kiely; Susan C Pitt; William S Rilling; Edward J Quebbeman; Stuart D Wilson; Henry A Pitt Journal: Ann Surg Date: 2005-05 Impact factor: 12.969
Authors: Evan S Glazer; Jennifer F Tseng; Waddah Al-Refaie; Carmen C Solorzano; Ping Liu; Katherine A Willborn; Eddie K Abdalla; Jean-Nicolas Vauthey; Steven A Curley Journal: HPB (Oxford) Date: 2010-08 Impact factor: 3.647
Authors: Steven D Scoville; Dimitrios Xourafas; Aslam M Ejaz; Allan Tsung; Timothy Pawlik; Jordan M Cloyd Journal: World J Gastrointest Surg Date: 2020-04-27
Authors: Rongzhi Wang; Rui Zheng-Pywell; H Alexander Chen; James A Bibb; Herbert Chen; J Bart Rose Journal: Clin Med Insights Endocrinol Diabetes Date: 2019-10-24
Authors: Andreas Selberherr; Simon Freermann; Oskar Koperek; Martin B Niederle; Philipp Riss; Christian Scheuba; Bruno Niederle Journal: Orphanet J Rare Dis Date: 2021-01-14 Impact factor: 4.123