Outcomes of laparoscopic tumor ablation for neuroendocrine liver metastases: a 20-year experience
- 45 Downloads
Since neuroendocrine tumors have an indolent behavior, studies looking at oncologic outcomes should report a long-term follow-up. Over the years, we have been treating selected patients with neuroendocrine liver metastases (NELM) with laparoscopic ablation (LA) and reported favorable local tumor control. The aim of this study is to see whether this local efficacy translates into long-term oncologic outcomes.
This was an IRB-approved study of patients who underwent LA for NELM at a single center. Overall and progression-free survivals were analyzed using Kaplan–Meier and Cox proportional hazards model.
Study included 58 women and 71 men with a median age of 58 (IQR 47–67) years. Tumor type included carcinoid (n = 92), pancreatic islet cell (n = 28), and medullary thyroid cancer (n = 9). There was a median of 6 (IQR 3–8) tumors, measuring 1.6 (IQR 1.1–2.4) cm. At a median follow-up of 73 (IQR 34–135) months, local liver recurrence per patient, new liver recurrence, and new extrahepatic recurrence rates were 22, 68, and 33%, respectively. Local tumor recurrence per lesion was 5% (n = 42/770). Median overall survival was 125 months, with 5-year, and 10-year overall survivals being, 76%, and 59%, respectively; and median disease-free survival was 13 months, with 5-year, and 10-year progression-free survivals being 26%, and 6%, respectively. On Cox proportional hazards model, overall survival was independently predicted by tumor size, grade, and resection status of primary.
To our knowledge, this is the largest single-center experience with the longest follow-up regarding the utilization of LA for NELM. Our results demonstrate that in selected patients, LA achieves a 95% local tumor control and 59% 10-year overall survival.
KeywordsLaparoscopic surgery Laparoscopic ablation Liver resection Local tumor control
Dr. Emin Kose is a recipient of International Postdoctoral Research Fellowship Program scholarship awarded by The Scientific and Technological Research Council of Turkey (TUBITAK).
No financial support was received for this study.
Compliance with ethical standards
Dr. Eren Berber is consultant for Ethicon, Medtronics and Aesculap Inc. and has received honoraria for consulting activities. Drs. Emin Kose, Bora Kahramangil, Husnu Aydin, Mustafa Donmez, Hideo Takahashi, Federico Aucejo, and Allan Siperstein have no conflicts of interest or financial ties to disclose.
- 2.Thompson GB, van Heerden JA, Grant CS, Carney JA, Ilstrup DM (1988) Islet cell carcinomas of the pancreas: a 20-year experience. Surgery 104:1011–1017Google Scholar
- 4.Ejaz A, Reames BN, Maithel S, Poultsides GA, Bauer TW, Fields RC, Weiss M, Marques HP, Aldrighetti L, Pawlik TM (2017) The impact of extrahepatic disease among patients undergoing liver-directed therapy for neuroendocrine liver metastasis. J Surg Oncol 116(7):841–847. https://doi.org/10.1002/jso.24727 CrossRefGoogle Scholar
- 7.Maire F, Hammel P, Kianmanesh R, Hentic O, Couvelard A, Rebours V, Zappa M, Raymond E, Sauvanet A, Louvet C, Lévy P, Belghiti J, Ruszniewski P (2009) Is adjuvant therapy with streptozotocin and 5-fluorouracil useful after resection of liver metastases from digestive endocrine tumors? Surgery 145:69–75. https://doi.org/10.1016/j.surg.2008.08.007 CrossRefGoogle Scholar
- 8.di Bartolomeo M, Bajetta E, Buzzoni R, Mariani L, Carnaghi C, Somma L, Zilembo N, di Leo A (1996) Clinical efficacy of octreotide in the treatment of metastatic neuroendocrine tumors. A study by the Italian Trials in Medical Oncology Group. Cancer 77:402–408. https://doi.org/10.1002/(SICI)1097-0142(19960115)77:2%3c402:AID-CNCR25%3e3.0.CO;2-4 CrossRefGoogle Scholar
- 9.Frilling A, Modlin IM, Kidd M, Russell C, Breitenstein S, Salem R, Kwekkeboom D, Lau W, Klersy C, Vilgrain V, Davidson B, Siegler M, Caplin M, Solcia E, Schilsky R (2014) Recommendations for management of patients with neuroendocrine liver metastases. Lancet Oncol 15:e8–e21. https://doi.org/10.1016/S1470-2045(13)70362-0 CrossRefGoogle Scholar
- 11.Fairweather M, Swanson R, Wang J, Brais LK, Dutton T, Kulke MH, Clancy TE (2017) Management of neuroendocrine tumor liver metastases: long-term outcomes and prognostic factors from a large prospective database. Ann Surg Oncol 24:2319–2325. https://doi.org/10.1245/s10434-017-5839-x CrossRefGoogle Scholar
- 14.Mayo SC, de Jong MC, Pulitano C, Clary BM, Reddy SK, Gamblin TC, Celinksi SA, Kooby DA, Staley CA, Stokes JB, Chu CK, Ferrero A, Schulick RD, Choti MA, Mentha G, Strub J, Bauer TW, Adams RB, Aldrighetti L, Capussotti L, Pawlik TM (2010) Surgical management of hepatic neuroendocrine tumor metastasis: results from an international multi-institutional analysis. Ann Surg Oncol 17:3129–3136. https://doi.org/10.1245/s10434-010-1154-5 CrossRefGoogle Scholar
- 15.Bagante F, Spolverato G, Merath K, Postlewait LM, Poultsides GA, Mullen MG, Bauer TW, Fields RC, Lamelas J, Marques HP, Aldrighetti L, Tran T, Maithel SK, Pawlik TM (2017) Neuroendocrine liver metastasis: the chance to be cured after liver surgery. J Surg Oncol 115:687–695. https://doi.org/10.1002/jso.24563 CrossRefGoogle Scholar
- 16.Saxena A, Chua TC, Sarkar A, Chu F, Liauw W, Zhao J, Morris DL (2011) Progression and survival results after radical hepatic metastasectomy of indolent advanced neuroendocrine neoplasms (NENs) supports an aggressive surgical approach. Surgery 149:209–220. https://doi.org/10.1016/j.surg.2010.06.008 CrossRefGoogle Scholar
- 24.Yao JC, Hassan M, Phan A, Dagohoy C, Leary C, Mares JE, Abdalla EK, Fleming JB, Vauthey J-N, Rashid A, Evans DB (2008) One hundred years after “Carcinoid”: epidemiology of and prognostic factors for neuroendocrine tumors in 35,825 cases in the United States. J Clin Oncol 26:3063–3072. https://doi.org/10.1200/JCO.2007.15.4377 CrossRefGoogle Scholar