Repeat hepatectomy for patients with recurrent neuroendocrine liver metastasis: Comparison with first hepatectomy

The value of repeat hepatectomy for intrahepatic recurrence after curative resection of neuroendocrine liver metastasis (NELM) remains unclear. The aim of this retrospective cohort study was to determine the significance of repeat hepatectomy for recurrent NELM.

Patients who underwent hepatectomy for NELM between 1994 and 2016 were identified. The indications for a first hepatectomy were adequate liver remnant volume and no extrahepatic metastasis. The diagnosis of recurrent NELM was based on radiographic examinations. The indications for a repeat hepatectomy were the same as those for the first hepatectomy. Clinicopathologic factors, short-term survival, and long-term survival were investigated using clinical records.

Forty-four patients enrolled in this study. Thirty-three patients among them underwent a curative hepatectomy, and 28 of them developed recurrence. Of them, 16 patients underwent a repeat hepatectomy. The overall survival of the repeat hepatectomy cohort (n = 16) was significantly better than that of the no repeat hepatectomy cohort (n = 12) (P < .001). The progression free survival after the first hepatectomy (n = 44) and that after repeat hepatectomy (n = 16) were similar (P = .546). No significant difference was seen between the frequency of major complications (Clavien-Dindo score ≥ 3a) after the first and repeat hepatectomy (P = .279). No repeat hepatectomy (hazard ratio [HR] 5.0, P = .036) was identified as an independent predictive factor of a poor outcome among the recurrent cohort, along with the presence of multiple nodules (HR 26.2, P = .008) and a CA19-9 level ≥40 U/mL (HR 11.2, P = .012).

A repeat hepatectomy is feasible in selected patients with recurrent NELM.