Management and outcomes of patients with recurrent neuroendocrine liver metastasis after curative surgery: An international multi‐institutional analysis
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 dat...
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| Veröffentlicht in: | Journal of surgical oncology 2017-09, Vol.116 (3), p.298-306 |
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| creator | 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. |
| description | 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 |
| doi_str_mv | 10.1002/jso.24670 |
| format | Article |
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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.</description><identifier>ISSN: 0022-4790</identifier><identifier>EISSN: 1096-9098</identifier><identifier>DOI: 10.1002/jso.24670</identifier><identifier>PMID: 28513896</identifier><language>eng</language><publisher>United States: Wiley Subscription Services, Inc</publisher><subject>Aged ; Cancer surgery ; Chemotherapy ; Colorectal Neoplasms - mortality ; Colorectal Neoplasms - pathology ; Colorectal Neoplasms - therapy ; Combined Modality Therapy ; Female ; Hepatectomy ; Humans ; Liver ; Liver Neoplasms - mortality ; Liver Neoplasms - secondary ; Liver Neoplasms - surgery ; Male ; Metastasis ; Middle Aged ; NELM ; Neoplasm Recurrence, Local - mortality ; Neoplasm Recurrence, Local - therapy ; recurrence ; Reoperation ; Retrospective Studies ; Surgery ; Survival Rate ; Treatment Outcome</subject><ispartof>Journal of surgical oncology, 2017-09, Vol.116 (3), p.298-306</ispartof><rights>2017 Wiley Periodicals, Inc.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4160-a4ca7a261488d017cf19c9d93894812331ab5c0feb5cc214ed0e78d5494f0b933</citedby><cites>FETCH-LOGICAL-c4160-a4ca7a261488d017cf19c9d93894812331ab5c0feb5cc214ed0e78d5494f0b933</cites><orcidid>0000-0002-4828-8096</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1002%2Fjso.24670$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1002%2Fjso.24670$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,776,780,1411,27901,27902,45550,45551</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/28513896$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Spolverato, Gaya</creatorcontrib><creatorcontrib>Bagante, Fabio</creatorcontrib><creatorcontrib>Aldrighetti, Luca</creatorcontrib><creatorcontrib>Poultsides, George A.</creatorcontrib><creatorcontrib>Bauer, Todd W.</creatorcontrib><creatorcontrib>Fields, Ryan C.</creatorcontrib><creatorcontrib>Maithel, Shishir Kumar</creatorcontrib><creatorcontrib>Marques, Hugo P.</creatorcontrib><creatorcontrib>Weiss, Matthew</creatorcontrib><creatorcontrib>Pawlik, Timothy M.</creatorcontrib><title>Management and outcomes of patients with recurrent neuroendocrine liver metastasis after curative surgery: An international multi‐institutional analysis</title><title>Journal of surgical oncology</title><addtitle>J Surg Oncol</addtitle><description>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.</description><subject>Aged</subject><subject>Cancer surgery</subject><subject>Chemotherapy</subject><subject>Colorectal Neoplasms - mortality</subject><subject>Colorectal Neoplasms - pathology</subject><subject>Colorectal Neoplasms - therapy</subject><subject>Combined Modality Therapy</subject><subject>Female</subject><subject>Hepatectomy</subject><subject>Humans</subject><subject>Liver</subject><subject>Liver Neoplasms - mortality</subject><subject>Liver Neoplasms - secondary</subject><subject>Liver Neoplasms - surgery</subject><subject>Male</subject><subject>Metastasis</subject><subject>Middle Aged</subject><subject>NELM</subject><subject>Neoplasm Recurrence, Local - mortality</subject><subject>Neoplasm Recurrence, Local - therapy</subject><subject>recurrence</subject><subject>Reoperation</subject><subject>Retrospective Studies</subject><subject>Surgery</subject><subject>Survival Rate</subject><subject>Treatment Outcome</subject><issn>0022-4790</issn><issn>1096-9098</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1kU1uFDEQhS1ERIbAggsgS2zCohPb7em22UURP0FBWQDrlsddHTxy24N_Es2OI7DmeJyESmbIAgnJKkuvvnqq0iPkBWcnnDFxus7xRMiuZ4_IgjPdNZpp9ZgssCca2Wt2SJ7mvGaMad3JJ-RQqCVvle4W5NcnE8w1zBAKNWGksRYbZ8g0TnRjikM901tXvtEEtqZ0xwWoKUIYo00uAPXuBhKdoZiMz2VqpoIC0jh_AzTXdA1p-4aeBeoCtgLqMRhP5-qL-_3jpwu5uFL3Ki7kt-jzjBxMxmd4vv-PyNd3b7-cf2gur95fnJ9dNlbyjjVGWtMb0XGp1Mh4byeurR413icVF23LzWpp2QRYreASRga9GpdSy4mtdNsekeOd7ybF7xVyGWaXLXhvAsSaB6607jXXLUP01T_oOla8xyOlRatVL3iP1OsdZVPMOcE0bJKbTdoOnA13gQ0Y2HAfGLIv9451NcP4QP5NCIHTHXDrPGz_7zR8_Hy1s_wDduSkvQ</recordid><startdate>20170901</startdate><enddate>20170901</enddate><creator>Spolverato, Gaya</creator><creator>Bagante, Fabio</creator><creator>Aldrighetti, Luca</creator><creator>Poultsides, George A.</creator><creator>Bauer, Todd W.</creator><creator>Fields, Ryan C.</creator><creator>Maithel, Shishir Kumar</creator><creator>Marques, Hugo P.</creator><creator>Weiss, Matthew</creator><creator>Pawlik, Timothy M.</creator><general>Wiley Subscription Services, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>K9.</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-4828-8096</orcidid></search><sort><creationdate>20170901</creationdate><title>Management and outcomes of patients with recurrent neuroendocrine liver metastasis after curative surgery: An international multi‐institutional analysis</title><author>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.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4160-a4ca7a261488d017cf19c9d93894812331ab5c0feb5cc214ed0e78d5494f0b933</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Aged</topic><topic>Cancer surgery</topic><topic>Chemotherapy</topic><topic>Colorectal Neoplasms - mortality</topic><topic>Colorectal Neoplasms - pathology</topic><topic>Colorectal Neoplasms - therapy</topic><topic>Combined Modality Therapy</topic><topic>Female</topic><topic>Hepatectomy</topic><topic>Humans</topic><topic>Liver</topic><topic>Liver Neoplasms - mortality</topic><topic>Liver Neoplasms - secondary</topic><topic>Liver Neoplasms - surgery</topic><topic>Male</topic><topic>Metastasis</topic><topic>Middle Aged</topic><topic>NELM</topic><topic>Neoplasm Recurrence, Local - mortality</topic><topic>Neoplasm Recurrence, Local - therapy</topic><topic>recurrence</topic><topic>Reoperation</topic><topic>Retrospective Studies</topic><topic>Surgery</topic><topic>Survival Rate</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Spolverato, Gaya</creatorcontrib><creatorcontrib>Bagante, Fabio</creatorcontrib><creatorcontrib>Aldrighetti, Luca</creatorcontrib><creatorcontrib>Poultsides, George A.</creatorcontrib><creatorcontrib>Bauer, Todd W.</creatorcontrib><creatorcontrib>Fields, Ryan C.</creatorcontrib><creatorcontrib>Maithel, Shishir Kumar</creatorcontrib><creatorcontrib>Marques, Hugo P.</creatorcontrib><creatorcontrib>Weiss, Matthew</creatorcontrib><creatorcontrib>Pawlik, Timothy M.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of surgical oncology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Spolverato, Gaya</au><au>Bagante, Fabio</au><au>Aldrighetti, Luca</au><au>Poultsides, George A.</au><au>Bauer, Todd W.</au><au>Fields, Ryan C.</au><au>Maithel, Shishir Kumar</au><au>Marques, Hugo P.</au><au>Weiss, Matthew</au><au>Pawlik, Timothy M.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Management and outcomes of patients with recurrent neuroendocrine liver metastasis after curative surgery: An international multi‐institutional analysis</atitle><jtitle>Journal of surgical oncology</jtitle><addtitle>J Surg Oncol</addtitle><date>2017-09-01</date><risdate>2017</risdate><volume>116</volume><issue>3</issue><spage>298</spage><epage>306</epage><pages>298-306</pages><issn>0022-4790</issn><eissn>1096-9098</eissn><abstract>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.</abstract><cop>United States</cop><pub>Wiley Subscription Services, Inc</pub><pmid>28513896</pmid><doi>10.1002/jso.24670</doi><tpages>9</tpages><orcidid>https://orcid.org/0000-0002-4828-8096</orcidid><oa>free_for_read</oa></addata></record> |
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| subjects | Aged Cancer surgery Chemotherapy Colorectal Neoplasms - mortality Colorectal Neoplasms - pathology Colorectal Neoplasms - therapy Combined Modality Therapy Female Hepatectomy Humans Liver Liver Neoplasms - mortality Liver Neoplasms - secondary Liver Neoplasms - surgery Male Metastasis Middle Aged NELM Neoplasm Recurrence, Local - mortality Neoplasm Recurrence, Local - therapy recurrence Reoperation Retrospective Studies Surgery Survival Rate Treatment Outcome |
| title | Management and outcomes of patients with recurrent neuroendocrine liver metastasis after curative surgery: An international multi‐institutional analysis |
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