Indications for Surgical Resection in Patients With Neuroendocrine Tumor Liver Metastases: An Intensive Surgical...

Surgical resection for neuroendocrine liver metastasis (NELM) is the key to long survival; however, the indications remain unclear due to the high recurrence rate. We aimed to identify candidates who would benefit from surgical resection for NELM.

Patients with NELM treated at our institution from January 2005 to December 2020 were included. Neuroendocrine carcinoma (NEC) was excluded. Risk factors for overall survival (OS) and recurrence-free survival (RFS) were analyzed. The cut-off value for the number of NELM predicting poor RFS was determined by minimum p-value approach.

Of the total 126 patients, 67 patients underwent liver resection. The median follow-up time from the date of initial diagnosis of NELM was 4.3 years. Surgical resection and NET-G1/2 were associated with good OS in multivariate analysis (p < 0.001). In patients underwent R0/1 resection (n = 44), NET-G3 [HR: 3.1 (95% CI 1.4-7.2)] and the number of NELM [HR: 1.1 (95% CI 1.0-1.1)] were associated with poor RFS in multivariate analysis. The optimal cut-off value for the number of NELM was calculated as 8. The median RFS for patients with 8 or more liver metastases or NET-G3 was 3.9 months, which was extremely short compared to patients with NET-G1/2 (13.8 months) and to those who had fewer than 8 liver metastases (19.1 months).

This study suggests that fewer than 8 liver metastases and NET-G1/2 are indications for surgical resection in patients with NELM considering the RFS. Surgical resection for patients with 8 or more liver metastases or NET-G3 needs deliberate selection.