Cytoreductive debulking surgery among patients with neuroendocrine liver metastasis

a multi-institutional analysis

Aslam Ejaz, Bradley N Reames, Shishir Maithel, George A. Poultsides, Todd W. Bauer, Ryan C. Fields, Matthew J. Weiss, Hugo P. Marques, Luca Aldrighetti, Timothy M. Pawlik

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Background: Management of neuroendocrine liver metastasis (NELM) in the setting of unresectable disease is poorly defined and the role of debulking remains controversial. The objective of the current study was to define outcomes following non-curative intent liver-directed therapy (debulking) among patients with NELM. Methods: 612 patients were identified who underwent liver-directed therapy of NELM from a multi-institutional database. Outcomes were stratified according to curative (R0/R1) versus non-curative ≥ 80% debulking (R2). Results: 179 (29.2%) patients had an R2/debulking procedure. Patients undergoing debulking more commonly had more aggressive high-grade tumors (R0/R1: 12.8% vs. R2: 35.0%; P < 0.001) or liver disease burden that was bilateral (R0/R1: 52.8% vs. R2: 75.6%; P < 0.001). After a median follow-up of 51 months, median (R0/R1: not reached vs. R2: 87 months; P < 0.001) and 5-year survival (R0/R1: 85.2% vs. R2: 60.7%; P < 0.001) was higher among patients who underwent an R0/R1 resection compared with patients who underwent a debulking operation. Among patients with ≥50% NELM liver involvement, median and 5-year survival following debulking was 55.4 months and 40.6%, respectively. Conclusion: Debulking operations for NELM provided reasonable long-term survival. Hepatic debulking for patients with NELM is a reasonable therapeutic option for patients with grossly unresectable disease that may provide a survival benefit.

Original languageEnglish (US)
Pages (from-to)277-284
Number of pages8
JournalHPB
Volume20
Issue number3
DOIs
StatePublished - Mar 1 2018

Fingerprint

Neoplasm Metastasis
Liver
Survival
Liver Diseases
Therapeutics
Databases
Neoplasms

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology

Cite this

Ejaz, A., Reames, B. N., Maithel, S., Poultsides, G. A., Bauer, T. W., Fields, R. C., ... Pawlik, T. M. (2018). Cytoreductive debulking surgery among patients with neuroendocrine liver metastasis: a multi-institutional analysis. HPB, 20(3), 277-284. https://doi.org/10.1016/j.hpb.2017.08.039

Cytoreductive debulking surgery among patients with neuroendocrine liver metastasis : a multi-institutional analysis. / Ejaz, Aslam; Reames, Bradley N; Maithel, Shishir; Poultsides, George A.; Bauer, Todd W.; Fields, Ryan C.; Weiss, Matthew J.; Marques, Hugo P.; Aldrighetti, Luca; Pawlik, Timothy M.

In: HPB, Vol. 20, No. 3, 01.03.2018, p. 277-284.

Research output: Contribution to journalArticle

Ejaz, A, Reames, BN, Maithel, S, Poultsides, GA, Bauer, TW, Fields, RC, Weiss, MJ, Marques, HP, Aldrighetti, L & Pawlik, TM 2018, 'Cytoreductive debulking surgery among patients with neuroendocrine liver metastasis: a multi-institutional analysis', HPB, vol. 20, no. 3, pp. 277-284. https://doi.org/10.1016/j.hpb.2017.08.039
Ejaz, Aslam ; Reames, Bradley N ; Maithel, Shishir ; Poultsides, George A. ; Bauer, Todd W. ; Fields, Ryan C. ; Weiss, Matthew J. ; Marques, Hugo P. ; Aldrighetti, Luca ; Pawlik, Timothy M. / Cytoreductive debulking surgery among patients with neuroendocrine liver metastasis : a multi-institutional analysis. In: HPB. 2018 ; Vol. 20, No. 3. pp. 277-284.
@article{2ad7c65f94534b849f40319d5606f914,
title = "Cytoreductive debulking surgery among patients with neuroendocrine liver metastasis: a multi-institutional analysis",
abstract = "Background: Management of neuroendocrine liver metastasis (NELM) in the setting of unresectable disease is poorly defined and the role of debulking remains controversial. The objective of the current study was to define outcomes following non-curative intent liver-directed therapy (debulking) among patients with NELM. Methods: 612 patients were identified who underwent liver-directed therapy of NELM from a multi-institutional database. Outcomes were stratified according to curative (R0/R1) versus non-curative ≥ 80{\%} debulking (R2). Results: 179 (29.2{\%}) patients had an R2/debulking procedure. Patients undergoing debulking more commonly had more aggressive high-grade tumors (R0/R1: 12.8{\%} vs. R2: 35.0{\%}; P < 0.001) or liver disease burden that was bilateral (R0/R1: 52.8{\%} vs. R2: 75.6{\%}; P < 0.001). After a median follow-up of 51 months, median (R0/R1: not reached vs. R2: 87 months; P < 0.001) and 5-year survival (R0/R1: 85.2{\%} vs. R2: 60.7{\%}; P < 0.001) was higher among patients who underwent an R0/R1 resection compared with patients who underwent a debulking operation. Among patients with ≥50{\%} NELM liver involvement, median and 5-year survival following debulking was 55.4 months and 40.6{\%}, respectively. Conclusion: Debulking operations for NELM provided reasonable long-term survival. Hepatic debulking for patients with NELM is a reasonable therapeutic option for patients with grossly unresectable disease that may provide a survival benefit.",
author = "Aslam Ejaz and Reames, {Bradley N} and Shishir Maithel and Poultsides, {George A.} and Bauer, {Todd W.} and Fields, {Ryan C.} and Weiss, {Matthew J.} and Marques, {Hugo P.} and Luca Aldrighetti and Pawlik, {Timothy M.}",
year = "2018",
month = "3",
day = "1",
doi = "10.1016/j.hpb.2017.08.039",
language = "English (US)",
volume = "20",
pages = "277--284",
journal = "HPB",
issn = "1365-182X",
publisher = "John Wiley and Sons Inc.",
number = "3",

}

TY - JOUR

T1 - Cytoreductive debulking surgery among patients with neuroendocrine liver metastasis

T2 - a multi-institutional analysis

AU - Ejaz, Aslam

AU - Reames, Bradley N

AU - Maithel, Shishir

AU - Poultsides, George A.

AU - Bauer, Todd W.

AU - Fields, Ryan C.

AU - Weiss, Matthew J.

AU - Marques, Hugo P.

AU - Aldrighetti, Luca

AU - Pawlik, Timothy M.

PY - 2018/3/1

Y1 - 2018/3/1

N2 - Background: Management of neuroendocrine liver metastasis (NELM) in the setting of unresectable disease is poorly defined and the role of debulking remains controversial. The objective of the current study was to define outcomes following non-curative intent liver-directed therapy (debulking) among patients with NELM. Methods: 612 patients were identified who underwent liver-directed therapy of NELM from a multi-institutional database. Outcomes were stratified according to curative (R0/R1) versus non-curative ≥ 80% debulking (R2). Results: 179 (29.2%) patients had an R2/debulking procedure. Patients undergoing debulking more commonly had more aggressive high-grade tumors (R0/R1: 12.8% vs. R2: 35.0%; P < 0.001) or liver disease burden that was bilateral (R0/R1: 52.8% vs. R2: 75.6%; P < 0.001). After a median follow-up of 51 months, median (R0/R1: not reached vs. R2: 87 months; P < 0.001) and 5-year survival (R0/R1: 85.2% vs. R2: 60.7%; P < 0.001) was higher among patients who underwent an R0/R1 resection compared with patients who underwent a debulking operation. Among patients with ≥50% NELM liver involvement, median and 5-year survival following debulking was 55.4 months and 40.6%, respectively. Conclusion: Debulking operations for NELM provided reasonable long-term survival. Hepatic debulking for patients with NELM is a reasonable therapeutic option for patients with grossly unresectable disease that may provide a survival benefit.

AB - Background: Management of neuroendocrine liver metastasis (NELM) in the setting of unresectable disease is poorly defined and the role of debulking remains controversial. The objective of the current study was to define outcomes following non-curative intent liver-directed therapy (debulking) among patients with NELM. Methods: 612 patients were identified who underwent liver-directed therapy of NELM from a multi-institutional database. Outcomes were stratified according to curative (R0/R1) versus non-curative ≥ 80% debulking (R2). Results: 179 (29.2%) patients had an R2/debulking procedure. Patients undergoing debulking more commonly had more aggressive high-grade tumors (R0/R1: 12.8% vs. R2: 35.0%; P < 0.001) or liver disease burden that was bilateral (R0/R1: 52.8% vs. R2: 75.6%; P < 0.001). After a median follow-up of 51 months, median (R0/R1: not reached vs. R2: 87 months; P < 0.001) and 5-year survival (R0/R1: 85.2% vs. R2: 60.7%; P < 0.001) was higher among patients who underwent an R0/R1 resection compared with patients who underwent a debulking operation. Among patients with ≥50% NELM liver involvement, median and 5-year survival following debulking was 55.4 months and 40.6%, respectively. Conclusion: Debulking operations for NELM provided reasonable long-term survival. Hepatic debulking for patients with NELM is a reasonable therapeutic option for patients with grossly unresectable disease that may provide a survival benefit.

UR - http://www.scopus.com/inward/record.url?scp=85030160268&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85030160268&partnerID=8YFLogxK

U2 - 10.1016/j.hpb.2017.08.039

DO - 10.1016/j.hpb.2017.08.039

M3 - Article

VL - 20

SP - 277

EP - 284

JO - HPB

JF - HPB

SN - 1365-182X

IS - 3

ER -