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Published on: March 3, 2023
Single center outcomes from parenchymal-sparing resections and microwave ablations for neuroendocrine tumor liver
Frances T Lee1, Jelani Williams2, Rachel Nordgren3
1Southern Illinois University, Department of Surgery. 701 N. 1st St, Springfield IL 62794, USA.
Background:
Reported outcomes after surgical debulking in patients with advanced neuroendocrine tumor liver metastases (NETLM) are sparse.
Methods:
NETLM patients that underwent surgical debulking from 2019 to 2021 were reviewed. Trends in perioperative liver function, complications, symptom response, and progression-free survival were examined.
Results:
1069 liver lesions were debulked from 53 patients using a combination of parenchymal-sparing resections (PSR) and ultrasound-guided microwave ablations (MWA). Post-operative transaminitis and thrombocytopenia were common, and severity correlated with increasing number of lesions. Laboratory markers for synthetic liver function did not differ according to the number of lesions debulked. 13% of patients sustained a Clavien-Dindo grade 3 or 4 complication which was not associated with the number of lesions targeted. All patients with preoperative symptoms had improvement after surgery. Median time to progression was 10.9 months.
Conclusions:
PSR with MWA for large numbers of NETLM is safe and effective for symptom control and does not affect synthetic liver function.
Insights
Surgical debulking using parenchymal-sparing resections (PSR) and microwave ablations (MWA) is safe for advanced neuroendocrine tumor liver metastases (NETLM). This approach effectively controls symptoms without impacting synthetic liver function.
Area of Science:
- Hepatobiliary surgery
- Surgical oncology
- Gastroenterology
Background:
- Outcomes for surgical debulking in advanced neuroendocrine tumor liver metastases (NETLM) are limited.
- NETLM presents significant management challenges due to its advanced nature.
Purpose of the Study:
- To evaluate the safety and efficacy of surgical debulking for NETLM.
- To analyze perioperative liver function, complications, symptom response, and progression-free survival.
Main Methods:
- Retrospective review of 53 NETLM patients undergoing surgical debulking (2019-2021).
- Combined use of parenchymal-sparing resections (PSR) and ultrasound-guided microwave ablations (MWA).
- Analysis of liver function, complications (Clavien-Dindo grade), symptom response, and time to progression.
Main Results:
- 53 patients underwent debulking of 1069 liver lesions.
- Postoperative transaminitis and thrombocytopenia were common, correlating with lesion number.
- No significant changes in synthetic liver function observed.
- 13% experienced severe complications (Clavien-Dindo grade 3-4), unrelated to lesion count.
- All patients reported symptom improvement post-surgery.
- Median time to progression was 10.9 months.
Conclusions:
- Combined PSR and MWA is a safe and effective strategy for managing large numbers of NETLM.
- Symptom control is a key benefit of this surgical approach.
- Synthetic liver function remains preserved after extensive debulking.
