Role of Ablation Therapy in Conjunction with Surgical Resection for Neuroendocrine Tumors Involving the Liver

Overview

Journal World J Gastrointest Surg

Publisher Baishideng Publishing Group

Specialty Gastroenterology

Date 2024 Apr 5

PMID 38577070

Authors

Alexander Ostapenko

Stephanie Stroever

Lud Eyasu

Minha Kim

Krist Aploks

Xiang Da Dong

Ramanathan Seshadri

Affiliations

Soon will be listed here.

Abstract

Background: Resection of hepatic metastasis from neuroendocrine tumors (NETs) improves quality of life and prolongs 5-year survival. Ablation can be utilized with surgery to achieve complete resection. Although several studies report long-term outcomes for patients undergoing ablation, none have explored perioperative effects of ablation in patients with metastatic NETs.

Aim: To determine if intra-operative ablation during hepatectomy increases risk of adverse outcomes such as surgical site infections (SSIs), bleeding, and bile leak.

Methods: A retrospective analysis of the hepatectomy National Surgical Quality Improvement Program database from 2015-2019 was performed to determine the odds of SSIs, bile leaks, or bleeding in patients undergoing intraoperative ablation when compared to hepatectomy alone.

Results: Of the 966 patients included in the study, 298 (30.9%) underwent ablation during hepatectomy. There were 78 (11.7%) patients with SSIs in the hepatectomy alone group and 39 (13.1%) patients with a SSIs in the hepatectomy with ablation group. Bile leak occurred in 41 (6.2%) and 14 (4.8%) patients in the two groups, respectively; bleeding occurred in 117 (17.5%) and 33 (11.1%), respectively. After controlling for confounding variables, ablation did not increase risk of SSI ( = 0.63), bile leak ( = 0.34) or bleeding ( = 0.07) when compared to patients undergoing resection alone on multivariate analysis.

Conclusion: Intraoperative ablation with hepatic resection for NETs is safe in the perioperative period without significant increased risk of infection, bleeding, or bile leak. Surgeons should utilize this modality when appropriate to achieve optimal disease control and outcomes.

References

Gut P . Liver metastases in gastroenteropancreatic neuroendocrine tumours - treatment methods. Prz Gastroenterol. 2020; 15(3):207-214. PMC: 7509904. DOI: 10.5114/pg.2020.91501. View

Shi Q, Xue C, He Y, Hu X, Yu Z . Massive abdominal hemorrhage after radiofrequency ablation of recurrent hepatocellular carcinoma with successful hemostasis achieved through transarterial embolization: a case report. J Int Med Res. 2020; 48(2):300060519898012. PMC: 7111056. DOI: 10.1177/0300060519898012. View

Curley S, Marra P, Beaty K, Ellis L, Nicolas Vauthey J, Abdalla E . Early and late complications after radiofrequency ablation of malignant liver tumors in 608 patients. Ann Surg. 2004; 239(4):450-8. PMC: 1356249. DOI: 10.1097/01.sla.0000118373.31781.f2. View

McDermott S, Gervais D . Radiofrequency ablation of liver tumors. Semin Intervent Radiol. 2014; 30(1):49-55. PMC: 3700792. DOI: 10.1055/s-0033-1333653. View

Atwell T, Charboneau J, Que F, Rubin J, Lewis B, Nagorney D . Treatment of neuroendocrine cancer metastatic to the liver: the role of ablative techniques. Cardiovasc Intervent Radiol. 2005; 28(4):409-21. DOI: 10.1007/s00270-004-4082-6. View

Odisio B, Richter M, Aloia T, Conrad C, Ahrar K, Gupta S . Use of Prophylactic Antibiotics to Prevent Abscess Formation Following Hepatic Ablation in Patients with Prior Enterobiliary Manipulation. J Gastrointest Surg. 2016; 20(8):1428-34. PMC: 4938743. DOI: 10.1007/s11605-016-3117-z. View

Park E, Kim H, Kim C, Hur Y, Koh Y, Kim J . A comparison between surgical resection and radiofrequency ablation in the treatment of hepatocellular carcinoma. Ann Surg Treat Res. 2014; 87(2):72-80. PMC: 4127905. DOI: 10.4174/astr.2014.87.2.72. View

Izzo F, Granata V, Grassi R, Fusco R, Palaia R, Delrio P . Radiofrequency Ablation and Microwave Ablation in Liver Tumors: An Update. Oncologist. 2019; 24(10):e990-e1005. PMC: 6795153. DOI: 10.1634/theoncologist.2018-0337. View

Dimick J, Wainess R, Cowan J, Upchurch Jr G, Knol J, Colletti L . National trends in the use and outcomes of hepatic resection. J Am Coll Surg. 2004; 199(1):31-8. DOI: 10.1016/j.jamcollsurg.2004.03.005. View

10.

Stroever S, Ostapenko A, Casasanta M . Racial Disparities and Upward Trend in Bowel Preparation for Elective Colectomy in the National Surgical Quality Improvement Program Procedure Targeted Dataset: 2012 to 2018. Ann Surg Open. 2023; 2(3):e092. PMC: 10455214. DOI: 10.1097/AS9.0000000000000092. View

11.

Shiina S, Sato K, Tateishi R, Shimizu M, Ohama H, Hatanaka T . Percutaneous Ablation for Hepatocellular Carcinoma: Comparison of Various Ablation Techniques and Surgery. Can J Gastroenterol Hepatol. 2018; 2018:4756147. PMC: 6008833. DOI: 10.1155/2018/4756147. View

12.

Dong J, Yang S, Zeng J, Cai S, Ji W, Duan W . Precision in liver surgery. Semin Liver Dis. 2013; 33(3):189-203. DOI: 10.1055/s-0033-1351781. View

13.

Schullian P, Johnston E, Laimer G, Putzer D, Eberle G, Amann A . Frequency and risk factors for major complications after stereotactic radiofrequency ablation of liver tumors in 1235 ablation sessions: a 15-year experience. Eur Radiol. 2020; 31(5):3042-3052. PMC: 8043912. DOI: 10.1007/s00330-020-07409-0. View

14.

Knox C, Anderson C, Lamps L, Adkins R, Pinson C . Long-term survival after resection for primary hepatic carcinoid tumor. Ann Surg Oncol. 2003; 10(10):1171-5. DOI: 10.1245/aso.2003.04.533. View

15.

Mulier S, Mulier P, Ni Y, Miao Y, Dupas B, Marchal G . Complications of radiofrequency coagulation of liver tumours. Br J Surg. 2002; 89(10):1206-22. DOI: 10.1046/j.1365-2168.2002.02168.x. View

16.

Karavokyros I, Orfanos S, Angelou A, Meropouli A, Schizas D, Griniatsos J . Incidence and Risk Factors for Organ/Space Infection after Radiofrequency-Assisted Hepatectomy or Ablation of Liver Tumors in a Single Center: More than Meets the Eye. Front Surg. 2017; 4:17. PMC: 5384425. DOI: 10.3389/fsurg.2017.00017. View

17.

Massarweh N, Park J, Farjah F, Yeung R, Symons R, Vaughan T . Trends in the utilization and impact of radiofrequency ablation for hepatocellular carcinoma. J Am Coll Surg. 2010; 210(4):441-8. PMC: 2847589. DOI: 10.1016/j.jamcollsurg.2009.12.026. View

18.

Reed Jr D, Vitale G, Wrightson W, Edwards M, McMasters K . Decreasing mortality of bile leaks after elective hepatic surgery. Am J Surg. 2003; 185(4):316-8. DOI: 10.1016/s0002-9610(02)01419-8. View

19.

Iida H, Aihara T, Ikuta S, Yamanaka N . Risk of abscess formation after liver tumor radiofrequency ablation: a review of 8 cases wtih a history of enterobiliary anastomosis. Hepatogastroenterology. 2015; 61(135):1867-70. View

20.

Su X, Li N, Chen X, Zhang L, Yan M . Incidence and Risk Factors for Liver Abscess After Thermal Ablation of Liver Neoplasm. Hepat Mon. 2016; 16(7):e34588. PMC: 5018304. DOI: 10.5812/hepatmon.34588. View