Liver Resection for Gastroenteropancreatic Neuroendocrine Tumors with Extrahepatic Disease

Overview

Journal J Clin Med

Specialty General Medicine

Date 2024 Sep 14

PMID 39274193

Authors

Kelly M Mahuron

Kristen E Limbach

Matthew C Hernandez

Philip H G Ituarte

Daneng Li

Jonathan Kessler

Gagandeep Singh

Affiliations

Soon will be listed here.

Abstract

: Although survival outcomes for neuroendocrine liver metastases (NETLM) are improved with liver-direct therapies (LDT), including hepatic debulking and nonsurgical trans-arterial embolization, the benefit is less established in the setting of concurrent extrahepatic disease (EHD). We performed a population-based study to characterize the rates of LDT being performed for NETLM with EHD patients and whether LDT is associated with survival outcomes. : Patients with NETLM and EHD were identified using the California Cancer Registry database merged with data from the California Office of Statewide Health Planning and Development between 2000 and 2012. Demographics, clinical characteristics, and survival outcomes were analyzed for these patients with and without LDT. : 327 NETLM patients with EHD were identified. EHD sites included lung, peritoneum, bone, and brain. A total of 71 (22%) of these patients underwent LDT. Compared to NETLM with EHD patients who did not undergo LDT, patients who received LDT had longer median overall survival (27 vs. 16 months, = 0.006). Within the LDT group, 23 patients underwent liver resection. Liver resection was associated with longer median overall survival compared to nonsurgical LDT (138 vs. 13 months, < 0.001). : LDT candidacy should be determined for patients on a case-by-case basis, but the presence of EHD should not preclude LDT with appropriate patient selection.

References

Arrivi G, Verrico M, Roberto M, Barchiesi G, Faggiano A, Marchetti P . Capecitabine and Temozolomide (CAPTEM) in Advanced Neuroendocrine Neoplasms (NENs): A Systematic Review and Pooled Analysis. Cancer Manag Res. 2022; 14:3507-3523. PMC: 9790144. DOI: 10.2147/CMAR.S372776. View

Tai E, Kennedy S, Farrell A, Jaberi A, Kachura J, Beecroft R . Comparison of transarterial bland and chemoembolization for neuroendocrine tumours: a systematic review and meta-analysis. Curr Oncol. 2020; 27(6):e537-e546. PMC: 7755439. DOI: 10.3747/co.27.6205. View

Jia Z, Wang W . Yttrium-90 radioembolization for unresectable metastatic neuroendocrine liver tumor: A systematic review. Eur J Radiol. 2018; 100:23-29. DOI: 10.1016/j.ejrad.2018.01.012. View

Saxena A, Chua T, Chu F, Al-Zahrani A, Morris D . Optimizing the surgical effort in patients with advanced neuroendocrine neoplasm hepatic metastases: a critical analysis of 40 patients treated by hepatic resection and cryoablation. Am J Clin Oncol. 2011; 35(5):439-45. DOI: 10.1097/COC.0b013e31821bc8dd. View

Yao J, Pavel M, Lombard-Bohas C, Van Cutsem E, Voi M, Brandt U . Everolimus for the Treatment of Advanced Pancreatic Neuroendocrine Tumors: Overall Survival and Circulating Biomarkers From the Randomized, Phase III RADIANT-3 Study. J Clin Oncol. 2016; 34(32):3906-3913. PMC: 5791842. DOI: 10.1200/JCO.2016.68.0702. View

Adam R, Delvart V, Pascal G, Valeanu A, Castaing D, Azoulay D . Rescue surgery for unresectable colorectal liver metastases downstaged by chemotherapy: a model to predict long-term survival. Ann Surg. 2004; 240(4):644-57. PMC: 1356466. DOI: 10.1097/01.sla.0000141198.92114.f6. View

Leung U, Gonen M, Allen P, Kingham T, DeMatteo R, Jarnagin W . Colorectal Cancer Liver Metastases and Concurrent Extrahepatic Disease Treated With Resection. Ann Surg. 2016; 265(1):158-165. PMC: 4942404. DOI: 10.1097/SLA.0000000000001624. View

Fallows M, Samant A, Wilson H, Mirnezami R . A Systematic Review of Surgical Management Strategies in the Treatment of Peritoneal Carcinomatosis of Neuroendocrine Origin. Curr Oncol. 2023; 30(7):6316-6329. PMC: 10378295. DOI: 10.3390/curroncol30070466. View

Mayo S, Jong M, Pulitano C, Clary B, Reddy S, Clark Gamblin T . Surgical management of hepatic neuroendocrine tumor metastasis: results from an international multi-institutional analysis. Ann Surg Oncol. 2010; 17(12):3129-36. DOI: 10.1245/s10434-010-1154-5. View

10.

Kennedy A, Bester L, Salem R, Sharma R, Parks R, Ruszniewski P . Role of hepatic intra-arterial therapies in metastatic neuroendocrine tumours (NET): guidelines from the NET-Liver-Metastases Consensus Conference. HPB (Oxford). 2014; 17(1):29-37. PMC: 4266438. DOI: 10.1111/hpb.12326. View

11.

Xu Z, Wang L, Dai S, Chen M, Li F, Sun J . Epidemiologic Trends of and Factors Associated With Overall Survival for Patients With Gastroenteropancreatic Neuroendocrine Tumors in the United States. JAMA Netw Open. 2021; 4(9):e2124750. PMC: 8461504. DOI: 10.1001/jamanetworkopen.2021.24750. View

12.

Mahuron K, Singh G . Defining a New Classification System for the Surgical Management of Neuroendocrine Tumor Liver Metastases. J Clin Med. 2023; 12(7). PMC: 10095340. DOI: 10.3390/jcm12072456. View

13.

Limbach K, Pommier R . Management of Metastatic GEPNETs. Surg Oncol Clin N Am. 2020; 29(2):281-292. DOI: 10.1016/j.soc.2019.11.001. View

14.

Chauhan A, Del Rivero J, Ramirez R, Soares H, Li D . Treatment Sequencing Strategies in Advanced Neuroendocrine Tumors: A Review. Cancers (Basel). 2022; 14(21). PMC: 9656186. DOI: 10.3390/cancers14215248. View

15.

Howe J, Cardona K, Fraker D, Kebebew E, Untch B, Wang Y . The Surgical Management of Small Bowel Neuroendocrine Tumors: Consensus Guidelines of the North American Neuroendocrine Tumor Society. Pancreas. 2017; 46(6):715-731. PMC: 5502737. DOI: 10.1097/MPA.0000000000000846. View

16.

Yao J, Hassan M, Phan A, Dagohoy C, Leary C, Mares J . One hundred years after "carcinoid": epidemiology of and prognostic factors for neuroendocrine tumors in 35,825 cases in the United States. J Clin Oncol. 2008; 26(18):3063-72. DOI: 10.1200/JCO.2007.15.4377. View

17.

Diez M, Teule A, Salazar R . Gastroenteropancreatic neuroendocrine tumors: diagnosis and treatment. Ann Gastroenterol. 2014; 26(1):29-36. PMC: 3959515. View

18.

Howe J, Merchant N, Conrad C, Keutgen X, Hallet J, Drebin J . The North American Neuroendocrine Tumor Society Consensus Paper on the Surgical Management of Pancreatic Neuroendocrine Tumors. Pancreas. 2019; 49(1):1-33. PMC: 7029300. DOI: 10.1097/MPA.0000000000001454. View

19.

Deyo R, Cherkin D, Ciol M . Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases. J Clin Epidemiol. 1992; 45(6):613-9. DOI: 10.1016/0895-4356(92)90133-8. View

20.

Basturk O, Tang L, Hruban R, Adsay V, Yang Z, Krasinskas A . Poorly differentiated neuroendocrine carcinomas of the pancreas: a clinicopathologic analysis of 44 cases. Am J Surg Pathol. 2014; 38(4):437-47. PMC: 3977000. DOI: 10.1097/PAS.0000000000000169. View