Elsevier

Surgery

Volume 133, Issue 4, April 2003, Pages 375-382
Surgery

Original Communications
Liver resection (and associated extrahepatic resections) for metastatic well-differentiated endocrine tumors: A 15-year single center prospective study*,**

https://doi.org/10.1067/msy.2003.114Get rights and content

Abstract

Background. The timing and benefits of hepatectomy remain controversial for metastatic well-differentiated endocrine neoplasms, which are generally considered slow growth tumors. However, surveillance alone yields only a 22% 5-year survival when metastases occur. The aim of this study was to determine the results of hepatic and extra hepatic resections and to clarify the indications of surgery. Methods. To define the role of hepatic resection, a database regrouping all patients (n = 47) who underwent hepatectomy with curative intent (R0 status) for well-differentiated endocrine neoplasms in the Gustave-Roussy Institute was constructed in 1984. New prognostic factors such as tumor growth and liver tumor mitotic index were studied. Median follow-up was 62 months. Results. Hepatectomy was associated with extrahepatic tumor resection in 77% of the patients (primary tumor in 51%, lymph nodes in 21%, peritoneal carcinomatosis in 25%, and other in 6%). Resection was curative (R0) only in 53% of the patients, despite removing at least 97% of the tumor in each patient. Mortality was 5%, and morbidity was 45%. Median survival was 91 months, 5-year and 10-year overall survival rates were 71% and 35%, respectively. Liver recurrence rate was 75% at 10 years. No prognostic factor was correlated with overall survival in this population in which at least 97% of the tumor load was resected. The completeness of surgery, the presence of bilateral liver metastases, the number of liver metastases (>10) and a primary tumor from pancreatic origin were all significantly correlated with the disease-free survival. Preoperative tumor growth rate, mitotic index, and Ki67 expression were not predictive of prognosis. No significant prognostic factors could be found by the comparison of the patients who did and did not recur during the 3 years after hepatectomy. Conclusion. Hepatectomy for liver metastases from well-differentiated endocrine neoplasms is indicated when all visible intra- and extra hepatic lesions can be resected safely. The number, size, and localization of the tumor sites are less important than performing a complete (or near-complete) resection. (Surgery 2003;133:375-82.)

Section snippets

Patients and methods

From January, 1985, to January, 2000, 112 patients treated in the Gustave-Roussy Institute for liver metastases from WDET origin were considered for hepatectomy. The inclusion criteria were: (1) complete resection of the tumor(s) seemed possible and was the primary objective; (2) primary tumor and regional lymph nodes had been previously resected or were potentially resectable, and the metastatic disease was confined to the liver or associated with resectable extrahepatic localization(s); (3)

Mortality-morbidity

Two deaths (secondary to pancreatitis and to hemorrhage) occurred postoperatively (5%) in patients with large primary pancreatic tumors (20 cm and 16 cm of diameter, respectively) and segmental portal hypertension. Both patients required difficult distal pancreatectomy and splenectomy because of extensive local tumor infiltration. Morbidity including minor complications was 45%; 22 complications were observed in 21 patients (including those who died) and are reported in Table III.

. Postoperative

Discussion

In patients with metastases from WDET, the treatment indications and impact remain poorly defined because of the low incidence of these tumors, the heterogeneous presentation, and the relatively long natural history even in presence of advanced disease. In spite of their reputation as slow-growing tumors, the analysis of the 8305 patients with carcinoid tumors collected in 2 US surveillance and epidemiologic programs revealed that only 22% of patients with distant metastases remain alive at 5

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  • Cited by (0)

    *

    Reprint requests: Elias Dominique, MD, PhD, Chief of Service, Department of Oncologic Surgery, Institut Gustave Roussy, Rue Camille Desmoulins, 94805, Villejuif, Cedex, France.

    **

    0039-6060/2003/$30.00 + 0

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