Introduction Approach to liver metastases in neuroendocrine tumours (NETs) significantly impacts on 5-year survival. A symptom based approach yields 5-year survival of 30% compared to >60% with multi-modal cytoreduction.1 At our NET tertiary referral centre patients are managed in line with the European Neuroendocrine Tumour Society guidelines,2 but with greater emphasis on multimodal cytoreduction for patients with unfavourable patterns of metastatic disease. We currently perform 60% of liver resections laparoscopically: over 300 procedures from 2003 to 2011. No existing study describes laparoscopic liver resections in patients with NETs. This study evaluates the feasibility and efficacy of the laparoscopic approach to liver resections in NETs in our tertiary referral unit.
Methods All patients assessed for intra-abdominal NETs from April 2005 to January 2012 were prospectively registered on a database. Patients undergoing laparoscopic liver resection were identified. Demographic, peri-operative and survival data were analysed using SPSS V.12.0. Severity of operative and post-operative morbidity was graded using the Clavien system.
Results The NET MDT assessed 239 patients. 99 patients had liver metastases; 58 underwent liver resection. 29 laparoscopic liver resections were performed on 27 patients (12F:15M), median age 63 (41–78). 11 major; eight minor and 10 multiple resections were performed. Intent of resection was curative (n=4), cytoreductive (n=19) or diagnostic/staging (n=6). Peri-operative mortality was 0% with no cases of carcinoid crisis, bile leak or port site metastases. Metastatic resections with no primary resection (n=27) had a complication rate of 11% (n=3) with no complication greater than grade IIIa. Median post-operative stay was 4 days (0–12). 24 patients are alive after median 32 months (9–64) follow-up post diagnosis and median 21 months (7–62) follow-up post surgery. 3 patients died of recurrence after median 25 months (20–30) follow-up post diagnosis and 20 months (16–25) follow-up post surgery.
Conclusion This is the first series to demonstrate laparoscopic liver resection for metastatic NETs can be performed with low morbidity and mortality by experienced surgeons in a tertiary referral unit.
Competing interests None declared.
References 1. Saxena A, Chua T, Sarkar A, et al. Progression and survival results after radial hepatic metastectomy of indolent advanced neuroendocrine neoplasms (NENs) supports and aggressive surgical approach. Surgery 2011;149:209–20.
2. Steinmuller T, Kianmanes R, Falconi M, et al. Consensus guidelines for the management of patients with liver metastases from digestive (neuro)endocrine tumors: foregut, midgut, hindgut and unknown primary. Neuro-endocrinology 2008;87:47–62.