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Management and outcomes of patients with recurrent neuroendocrine liver metastasis after curative surgery: An international multi‐institutional analysis
Author(s) -
Spolverato Gaya,
Bagante Fabio,
Aldrighetti Luca,
Poultsides George A.,
Bauer Todd W.,
Fields Ryan C.,
Maithel Shishir Kumar,
Marques Hugo P.,
Weiss Matthew,
Pawlik Timothy M.
Publication year - 2017
Publication title -
journal of surgical oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.201
H-Index - 111
eISSN - 1096-9098
pISSN - 0022-4790
DOI - 10.1002/jso.24670
Subject(s) - medicine , metastasis , neuroendocrine tumors , surgery , chemotherapy , gastroenterology , cancer
Objective We sought to characterize the treatment, as well as define the long‐term outcomes, of patients with recurrent neuroendocrine liver metastasis (NELM). Methods Between 1990 and 2014, 322 patients undergoing curative intent liver surgery for NELM were identified from a multi‐institutional database. Recurrences were classified as intrahepatic, extrahepatic, and both intra‐ and extra‐hepatic. Results Overall, median, 1‐, 5‐, 10‐year DFS were 3.1 years, 75.5%, 40.4%, and 32.1%, respectively. After curative intent liver surgery, 209 patients (64.9%) recurred within a median follow‐up of 4.5 years, while 113 (35.1%) patients were alive without disease with a follow‐up time ≥3 years. The site of recurrence was intrahepatic only ( n = 111, 65.7%), extrahepatic only ( n = 19, 11.2%), or intra‐ and extra‐hepatic ( n = 39, 23.1%). Compared with intrahepatic only recurrence, extrahepatic only, and combined intra‐ and extra‐hepatic recurrence were associated with a worse long‐term outcome (10‐year OS: intrahepatic only, 42.5%, 95%CI, 24.9‐59.0 vs extrahepatic only, 0% and combined intra‐ and extra‐hepatic, 21.5%, 95%CI, 5.3‐44.0) ( P < 0.001). Most patients were treated with repeat surgery ( n = 49, 36.6%), while 34 (23.5%) patients received a somatostatin analogue, 27 (18.6%) systemic cytotoxic chemotherapy, and 27 (21.4%) patients had intra‐arterial therapy. Ten‐year OS among patients who underwent repeat surgery or intra‐arterial treatments was 60.3% (95%CI, 34.1‐78.8) and 52.0% (95%CI, 30.6‐69.9), respectively. Patients who received somatostatin analogues (45.9% 95%CI, 22.3‐66.9) or systemic chemotherapy (0%) had a shorter long‐term survival ( P = 0.001). Conclusion Recurrence after surgery for NELM occurred among half of patients. Repeat liver resection for recurrence may offer a reasonable 5‐year survival benefit.