Journal of Gastrointestinal Surgery

, Volume 23, Issue 1, pp 122–134 | Cite as

Surgery Provides Long-Term Survival in Patients with Metastatic Neuroendocrine Tumors Undergoing Resection for Non-Hormonal Symptoms

  • Jeffery Chakedis
  • Eliza W. Beal
  • Alexandra G. Lopez-Aguiar
  • George Poultsides
  • Eleftherios Makris
  • Flavio G. Rocha
  • Zaheer Kanji
  • Sharon Weber
  • Alexander Fisher
  • Ryan Fields
  • Bradley A. Krasnick
  • Kamran Idrees
  • Paula Marincola-Smith
  • Clifford Cho
  • Megan Beems
  • Timothy M. Pawlik
  • Shishir K Maithel
  • Carl R. Schmidt
  • Mary DillhoffEmail author
2018 SSAT Plenary Presentation



Patients with metastatic neuroendocrine tumor (NET) often have an indolent disease course yet the outcomes for patients with metastatic NET undergoing surgery for non-hormonal (NH) symptoms of GI obstruction, bleeding, or pain is not known.


We identified patients with metastatic gastroenteropancreatic NET who underwent resection from 2000 to 2016 at 8 academic institutions who participated in the US Neuroendocrine Tumor Study Group.


Of 581 patients with metastatic NET to liver (61.3%), lymph nodes (24.1%), lung (2.1%), and bone (2.5%), 332 (57.1%) presented with NH symptoms of pain (n = 223, 67.4%), GI bleeding (n = 54, 16.3%), GI obstruction (n = 49, 14.8%), and biliary obstruction (n = 22, 6.7%). Most patients were undergoing their first operation (85.4%) within 4 weeks of diagnosis. The median overall survival was 110.4 months, and operative intent predicted survival (p < 0.001) with 66.3% undergoing curative resection. Removal of all metastatic disease was associated with the longest median survival (112.5 months) compared to debulking (89.2 months), or palliative resection (50.0 months; p < 0.001). The 1-, 3-, and 12-month mortality was 3.0%, 4.5%, and 9.0%, respectively. Factors associated with 1-year mortality included palliative operations (OR 6.54, p = 0.006), foregut NET (5.62, p = 0.042), major complication (4.91, p = 0.001), and high tumor grade (11.2, p < 0.001). The conditional survival for patients who lived past 1 year was 119 months.


Patients with metastatic NET and NH symptoms that necessitate surgery have long-term survival, and goals of care should focus on both oncologic and quality of life impact. Surgical intervention remains a critical component of multidisciplinary care of symptomatic patients.


Neuroendocrine tumor Metastatic Non-hormonal Symptoms Palliative surgery 


Authors’ Contributions

Study Design: Jeffery Chakedis, Eliza W. Beal, Timothy M. Pawlik, Carl R. Schmidt, Mary Dillhoff.

Data Acquisition: Jeffery Chakedis, Eliza W. Beal, Alexandra G. Lopez-Aguiar, George Poultsides, Eleftherios Makris, Flavio G. Rocha, Zaheer Kanji, Sharon Weber, Alexander Fisher, Ryan Fields, Bradley A. Krasnick, Kamran Idrees, Paula Marincola-Smith, Clifford Cho, Megan Beems, Timothy M. Pawlik, Shishir K Maithel, Carl R. Schmidt, Mary Dillhoff.

Data Analysis/Interpretation: Jeffery Chakedis, Eliza W. Beal, Carl R. Schmidt, Mary Dillhoff.

Manuscript Preparation/Approval: Jeffery Chakedis, Eliza W. Beal, Alexandra G. Lopez-Aguiar, George Poultsides, Eleftherios Makris, Flavio G. Rocha, Zaheer Kanji, Sharon Weber, Alexander Fisher, Ryan Fields, Bradley A. Krasnick, Kamran Idrees, Paula Marincola-Smith, Clifford Cho, Megan Beems, Timothy M. Pawlik, Shishir K Maithel, Carl R. Schmidt, Mary Dillhoff.

Compliance with Ethical Standards

The institutional review board from each institution approved the study

Conflict of Interest

The authors declare that they have no conflict of interest.

Supplementary material

11605_2018_3986_MOESM1_ESM.pdf (97 kb)
Supplemental Figure 1 Conditional overall survival of metastatic neuroendocrine tumor patients with non-hormonal symptoms who survived more than 1-year, n=302. (PDF 97 kb)


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Copyright information

© The Society for Surgery of the Alimentary Tract 2018

Authors and Affiliations

  • Jeffery Chakedis
    • 1
  • Eliza W. Beal
    • 1
  • Alexandra G. Lopez-Aguiar
    • 2
  • George Poultsides
    • 3
  • Eleftherios Makris
    • 3
  • Flavio G. Rocha
    • 4
  • Zaheer Kanji
    • 4
  • Sharon Weber
    • 5
  • Alexander Fisher
    • 5
  • Ryan Fields
    • 6
  • Bradley A. Krasnick
    • 6
  • Kamran Idrees
    • 7
  • Paula Marincola-Smith
    • 7
  • Clifford Cho
    • 8
  • Megan Beems
    • 8
  • Timothy M. Pawlik
    • 1
  • Shishir K Maithel
    • 2
  • Carl R. Schmidt
    • 1
  • Mary Dillhoff
    • 1
    Email author
  1. 1.Division of Surgical OncologyThe Ohio State University Wexner Medical Center and James Comprehensive Cancer CenterColumbusUSA
  2. 2.Division of Surgical Oncology, Department of Surgery, Emory UniversityWinship Cancer InstituteAtlantaUSA
  3. 3.Department of SurgeryStanford UniversityPalo AltoUSA
  4. 4.Department of SurgeryVirginia Mason Medical CenterSeattleUSA
  5. 5.Department of SurgeryUniversity of Wisconsin School of Medicine and Public HealthMadisonUSA
  6. 6.Department of SurgeryWashington University School of MedicineSt. LouisUSA
  7. 7.Division of Surgical Oncology, Department of SurgeryVanderbilt UniversityNashvilleUSA
  8. 8.Division of Hepatopancreatobiliary and Advanced Gastrointestinal Surgery, Department of SurgeryUniversity of MichiganAnn ArborUSA

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