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Hepatic Resection for Non-functional Neuroendocrine Liver Metastasis: Does the Presence of Unresected Primary Tumor or Extrahepatic Metastatic Disease Matter?

  • Gastrointestinal Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Objectives

The objective of this study was to assess the impact of unresected primary tumor, as well as extrahepatic metastasis, on the long-term prognosis of patients undergoing hepatic resection for non-functional neuroendocrine liver metastasis (NF-NELM).

Methods

Patients who underwent hepatic resection for NF-NELM were identified from a multi-institutional database. Data on clinical and pathological details, as well as the long-term overall survival (OS) were obtained and compared. Propensity score matching was performed to generate matched pairs of patients.

Results

Among the 332 patients with NF-NELM, 281 (84.6%) underwent primary tumor resection, while 51 (15.4%) did not. Patients who underwent primary resection were more likely to have a pancreatic primary and metachronous NELM. The long-term OS of patients who did and did not have the primary neuroendocrine tumor (NET) resected was comparable on both unmatched (10-year survival rate 66.8% vs. 54.0%, p = 0.192) and matched (10-year survival rate 75.7% vs. 60.4%, p = 0.271) analyses. In contrast, patients with NF-NELM and extrahepatic metastasis had a worse OS following resection compared with patients who had intrahepatic-only metastasis on unmatched (10-year survival rate 37.5% vs. 69.3%, p = 0.002) and matched (10-year survival rate 37.5% vs. 86.3%, p = 0.011) analyses. On multivariable analysis, while resection of the primary NET was not associated with OS (hazard ratio [HR] 0.7, 95% confidence interval [CI] 0.4–1.2, p = 0.195), the presence of extrahepatic metastasis was independently associated with long-term risk of death (HR 3.9, 95% CI 1.7–9.2, p = 0.002).

Conclusions

While surgery should be considered for patients with NF-NELM who have an unresectable primary tumor, operative resection of NF-NELM may not be as beneficial in patients with extrahepatic disease.

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Acknowledgment

Jun-Xi Xiang and Xu-Feng Zhang were supported by the Clinical Research Award of the First Affiliated Hospital of Xi’an Jiaotong University of China (No. XJTU1AF-CRF-2017-004).

Author information

Author notes

  1. Jun-Xi Xiang and Xu-Feng Zhang have contributed equally to the study.

Authors and Affiliations

  1. Department of Hepatobiliary Surgery and Institute of Advanced Surgical Technology and Engineering, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China

    Jun-Xi Xiang MD & Xu-Feng Zhang MD, PhD

  2. Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA

    Eliza W. Beal MD & Timothy M. Pawlik MD, MPH, PhD, FACS, FRACS (Hon.)

  3. Department of Surgery, Johns Hopkins Hospital, Baltimore, MD, USA

    Matthew Weiss MD

  4. Department of Surgery, Scientific Institute San Raffaele, Vita-Salute San Raffaele University, Milan, Italy

    Luca Aldrighetti MD

  5. Department of Surgery, Stanford University, Stanford, CA, USA

    George A. Poultsides MD

  6. Department of Surgery, University of Virginia, Charlottesville, VA, USA

    Todd W. Bauer MD

  7. Department of Surgery, Washington University, School of Medicine, St Louis, MO, USA

    Ryan C. Fields MD

  8. Department of Surgery, Emory University, Atlanta, GA, USA

    Shishir Kumar Maithel MD

  9. Department of Surgery, Curry Cabral Hospital, Lisbon, Portugal

    Hugo P. Marques MD

  10. Department of Surgery, The Shelly and Urban Meyer Professor of Cancer Research, The Ohio State University, Columbus, OH, USA

    Timothy M. Pawlik MD, MPH, PhD, FACS, FRACS (Hon.)

Authors
  1. Jun-Xi Xiang MD
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  2. Xu-Feng Zhang MD, PhD
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  3. Eliza W. Beal MD
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  4. Matthew Weiss MD
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  7. Todd W. Bauer MD
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  8. Ryan C. Fields MD
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  9. Shishir Kumar Maithel MD
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  10. Hugo P. Marques MD
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  11. Timothy M. Pawlik MD, MPH, PhD, FACS, FRACS (Hon.)
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Contributions

Study design: J.X. Xiang, X.F. Zhang, T.M. Pawlik. Data collection and interpretation: E.W. Beal, L. Aldrighetti, G.A. Poultsides, T.W. Bauer, R.C. Fields, S.K. Maithel, H.P. Marques, M. Weiss. Data analysis: J.X. Xiang, X.F. Zhang. Drafting of the manuscript: X.J. Xiang, X.F. Zhang. Revision of the draft version of the manuscript: X.F. Zhang, T.M. Pawlik.

Corresponding author

Correspondence to Timothy M. Pawlik MD, MPH, PhD, FACS, FRACS (Hon.).

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None declared.

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10434_2018_6751_MOESM1_ESM.tif

Overall survival of non-functional neuroendocrine liver metastasis patients who underwent hepatic resection in different eras (TIFF 3050 kb)

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Xiang, JX., Zhang, XF., Beal, E.W. et al. Hepatic Resection for Non-functional Neuroendocrine Liver Metastasis: Does the Presence of Unresected Primary Tumor or Extrahepatic Metastatic Disease Matter?. Ann Surg Oncol 25, 3928–3935 (2018). https://doi.org/10.1245/s10434-018-6751-8

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  • DOI: https://doi.org/10.1245/s10434-018-6751-8

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