Aaron T Scott1, Patrick J Breheny2, Kendall J Keck1, Andrew M Bellizzi3, Joseph S Dillon4, Thomas M O'Dorisio4, James R Howe5. 1. Department of Surgery, University of Iowa Carver College of Medicine, Iowa City. 2. Department of Biostatistics, University of Iowa College of Public Health, Iowa City. 3. Department of Pathology, University of Iowa Carver College of Medicine, Iowa City. 4. Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City. 5. Department of Surgery, University of Iowa Carver College of Medicine, Iowa City. Electronic address: james-howe@uiowa.edu.
Abstract
BACKGROUND: Cytoreductive surgery for neuroendocrine tumor liver metastases improves survival and symptomatic control. However, the feasibility of adequate cytoreduction in patients with many liver metastases remains uncertain. We compared patient outcomes based on the number of lesions treated to better define the efficacy of cytoreductive surgery for numerous neuroendocrine tumor liver metastases. METHODS: Patients undergoing hepatic cytoreductive surgery for gastroenteropancreatic neuroendocrine tumors were identified in our institutional surgical neuroendocrine tumor database. Imaging studies were reviewed to determine the liver tumor burden and percent cytoreduced. Overall survival and progression-free survival were compared, using the number of lesions treated, percent tumor debulked, and additional clinicopathologic characteristics. RESULTS: A total of 188 hepatic cytoreductive procedures were identified and stratified into groups according to the number of metastases treated: 1-5, 6-10, and >10. Median overall survival and progression-free survival were 89.4 and 22.5 months, respectively, and did not differ significantly between groups. Greater than 70% cytoreduction was associated with significantly better overall survival than <70% cytoreduction (134 months versus 38 months). CONCLUSION: In patients with gastroenteropancreatic neuroendocrine tumors and liver metastases, >70% cytoreduction led to improved overall survival and progression-free survival and was achieved reliably in patients undergoing debulking of >10 lesions. These data support an aggressive approach to patients with numerous neuroendocrine tumor liver metastases to achieve >70% cytoreduction.
BACKGROUND: Cytoreductive surgery for neuroendocrine tumor liver metastases improves survival and symptomatic control. However, the feasibility of adequate cytoreduction in patients with many liver metastases remains uncertain. We compared patient outcomes based on the number of lesions treated to better define the efficacy of cytoreductive surgery for numerous neuroendocrine tumor liver metastases. METHODS:Patients undergoing hepatic cytoreductive surgery for gastroenteropancreatic neuroendocrine tumors were identified in our institutional surgical neuroendocrine tumor database. Imaging studies were reviewed to determine the liver tumor burden and percent cytoreduced. Overall survival and progression-free survival were compared, using the number of lesions treated, percent tumor debulked, and additional clinicopathologic characteristics. RESULTS: A total of 188 hepatic cytoreductive procedures were identified and stratified into groups according to the number of metastases treated: 1-5, 6-10, and >10. Median overall survival and progression-free survival were 89.4 and 22.5 months, respectively, and did not differ significantly between groups. Greater than 70% cytoreduction was associated with significantly better overall survival than <70% cytoreduction (134 months versus 38 months). CONCLUSION: In patients with gastroenteropancreatic neuroendocrine tumors and liver metastases, >70% cytoreduction led to improved overall survival and progression-free survival and was achieved reliably in patients undergoing debulking of >10 lesions. These data support an aggressive approach to patients with numerous neuroendocrine tumor liver metastases to achieve >70% cytoreduction.
Authors: Sebastian Richards-Taylor; Sean M Ewings; Eleanor Jaynes; Charles Tilley; Sarah G Ellis; Thomas Armstrong; Neil Pearce; Judith Cave Journal: J Clin Pathol Date: 2015-12-17 Impact factor: 3.411
Authors: Dominique Elias; Philippe Lasser; Michel Ducreux; Pierre Duvillard; Jean-Francois Ouellet; Clarice Dromain; Martin Schlumberger; Marc Pocard; Valérie Boige; Catherine Miquel; Eric Baudin Journal: Surgery Date: 2003-04 Impact factor: 3.982
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: Juan M Sarmiento; Glenroy Heywood; Joseph Rubin; Duane M Ilstrup; David M Nagorney; Florencia G Que Journal: J Am Coll Surg Date: 2003-07 Impact factor: 6.113
Authors: James C Yao; Nicola Fazio; Simron Singh; Roberto Buzzoni; Carlo Carnaghi; Edward Wolin; Jiri Tomasek; Markus Raderer; Harald Lahner; Maurizio Voi; Lida Bubuteishvili Pacaud; Nicolas Rouyrre; Carolin Sachs; Juan W Valle; Gianfranco Delle Fave; Eric Van Cutsem; Margot Tesselaar; Yasuhiro Shimada; Do-Youn Oh; Jonathan Strosberg; Matthew H Kulke; Marianne E Pavel Journal: Lancet Date: 2015-12-17 Impact factor: 79.321
Authors: Arvind Dasari; Chan Shen; Daniel Halperin; Bo Zhao; Shouhao Zhou; Ying Xu; Tina Shih; James C Yao Journal: JAMA Oncol Date: 2017-10-01 Impact factor: 31.777
Authors: James R Howe; Nipun B Merchant; Claudius Conrad; Xavier M Keutgen; Julie Hallet; Jeffrey A Drebin; Rebecca M Minter; Terry C Lairmore; Jennifer F Tseng; Herbert J Zeh; Steven K Libutti; Gagandeep Singh; Jeffrey E Lee; Thomas A Hope; Michelle K Kim; Yusuf Menda; Thorvardur R Halfdanarson; Jennifer A Chan; Rodney F Pommier Journal: Pancreas Date: 2020-01 Impact factor: 3.327
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: Jordan M Cloyd; Aslam Ejaz; Bhavana Konda; Mina S Makary; Timothy M Pawlik Journal: Hepatobiliary Surg Nutr Date: 2020-08 Impact factor: 7.293
Authors: Yoshikuni Kawaguchi; Mario De Bellis; Elena Panettieri; Gregor Duwe; Jean-Nicolas Vauthey Journal: Surg Oncol Clin N Am Date: 2020-10-27 Impact factor: 3.495
Authors: Catherine G Tran; Scott K Sherman; Chandrikha Chandrasekharan; James R Howe Journal: Surg Oncol Clin N Am Date: 2020-10-20 Impact factor: 3.495