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Hepatic neuroendocrine metastases: does intervention alter outcomes?
R S Chamberlain1, D Canes, K T Brown
1Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA.
Journal of the American College of Surgeons
|April 11, 2000
Summary
Advanced neuroendocrine tumors with liver metastases require a multidisciplinary approach. Surgical resection and hepatic artery embolization (HAE) offer symptom relief, with resection potentially improving survival in select cases.
Area of Science:
- Oncology
- Hepatology
- Surgical Gastroenterology
Background:
- Advanced neuroendocrine tumors (NETs) often present with indolent behavior, but hepatic metastases are common.
- Liver metastases can cause significant morbidity, including pain and endocrinopathy, yet are frequently asymptomatic.
- The optimal management strategy for hepatic NET metastases, including hepatic artery embolization (HAE) and surgical resection, remains a subject of debate.
Purpose of the Study:
- To report overall survival in a cohort of patients with hepatic neuroendocrine tumor metastases.
- To analyze prognostic variables that may predict survival in this patient population.
- To evaluate the efficacy and outcomes of different treatment modalities for liver metastases from NETs.
Main Methods:
- A prospective database was used to review records of 85 patients treated for hepatic NET metastases between 1992 and 1998.
- Patient management involved a multidisciplinary team of surgeons, radiologists, and oncologists.
- Statistical analysis, including univariate and multivariate analyses, was performed to identify prognostic factors and assess treatment outcomes.
Main Results:
- The cohort comprised 37 men and 48 women with a median age of 52 years, including carcinoid tumors and various islet cell tumors.
- Thirty-eight patients had extrahepatic metastases, and 84% had bilobar liver involvement.
- Hepatic artery embolization (HAE) and surgical resection both had a 6% mortality rate. Curative intent was the only significant predictor of prolonged survival on multivariate analysis. One-, 3-, and 5-year survival rates for the entire group were 83%, 61%, and 53%, respectively.
Conclusions:
- A multidisciplinary approach is crucial for managing hepatic metastases from neuroendocrine tumors.
- Both HAE and surgical resection are effective in palliating hormonal symptoms and pain.
- While surgical resection can prolong survival in select patients, it rarely achieves a cure for hepatic NET metastases.