The Impact of Extent of Liver Resection Among Patients with Neuroendocrine Liver Metastasis

an International Multi-institutional Study

Jonathan G. Sham, Aslam Ejaz, Michele M. Gage, Fabio Bagante, Bradley N Reames, Shishir Maithel, George A. Poultsides, Todd W. Bauer, Ryan C. Fields, Matthew J. Weiss, Hugo Pinto Marques, Luca Aldrighetti, Timothy M. Pawlik, Jin He

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Background: Liver resection in patients with neuroendocrine liver metastasis (NELM) provides a survival benefit, yet the optimal extent of resection remains unknown. We sought to examine outcomes of patients undergoing non-anatomic (NAR) versus anatomic liver resection (AR) for NELM using a large international cohort of patients. Methods: Two hundred and fifty-eight patients who underwent curative intent liver resection from January 1990 to December 2016 were identified from eight institutions. Patients were excluded if they underwent concurrent ablation, had extrahepatic disease, underwent a debulking operation, or had mixed anatomic and non-anatomic resections. Overall (OS) and recurrence-free (RFS) survival were compared among patients based on the extent of liver resection (AR vs. NAR). Results: Most primary tumors were located in the pancreas (n = 117, 45.4%) or the small intestine (n = 65, 25.2%). Liver resection consisted of NAR (n = 126, 48.8%) or AR (n = 132, 51.2%) resection. The overwhelming majority of patients who underwent NAR had an estimated liver involvement of < 50% (NAR 109, 97.3% vs. AR n = 82, 65.6%; P < 0.001). Patients who underwent NAR also had higher rates of primary tumor lymph node metastasis (NAR n = 79, 71.2% vs. AR n = 37, 33.6%; P < 0.001) and microscopically positive margins (R1) (NAR n = 29, 25.7% vs. AR n = 16, 12.5%; P = 0.009). After a median follow-up of 47.7 months, 48 (18.6%) patients died and 37.0% (n = 95) had evidence of disease recurrence. Patients who underwent AR had both longer median OS (not reached) and RFS (not reached) versus patients who underwent NAR (median OS 138.3 months; median RFS 31.3 months) (both P < 0.01). After controlling for patient and disease-related factors, extent of liver resection was independently associated with an increased risk of recurrence (HR 2.39, 95% CI 1.04–5.48; P = 0.04) but not death (HR 1.92, 95% CI 0.40–9.28; P = 0.42). Conclusion: NAR was independently associated with a higher incidence of recurrence versus patients who undergo a formal anatomic hepatectomy among patients with NELM.

Original languageEnglish (US)
Pages (from-to)484-491
Number of pages8
JournalJournal of Gastrointestinal Surgery
Volume23
Issue number3
DOIs
StatePublished - Mar 15 2019

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Neoplasm Metastasis
Liver
Recurrence
Survival
Hepatectomy
Small Intestine
Pancreas
Neoplasms
Lymph Nodes
Incidence

Keywords

  • Anatomic resection
  • Hepatectomy
  • Neuroendocrine tumors

ASJC Scopus subject areas

  • Surgery
  • Gastroenterology

Cite this

The Impact of Extent of Liver Resection Among Patients with Neuroendocrine Liver Metastasis : an International Multi-institutional Study. / Sham, Jonathan G.; Ejaz, Aslam; Gage, Michele M.; Bagante, Fabio; Reames, Bradley N; Maithel, Shishir; Poultsides, George A.; Bauer, Todd W.; Fields, Ryan C.; Weiss, Matthew J.; Marques, Hugo Pinto; Aldrighetti, Luca; Pawlik, Timothy M.; He, Jin.

In: Journal of Gastrointestinal Surgery, Vol. 23, No. 3, 15.03.2019, p. 484-491.

Research output: Contribution to journalArticle

Sham, JG, Ejaz, A, Gage, MM, Bagante, F, Reames, BN, Maithel, S, Poultsides, GA, Bauer, TW, Fields, RC, Weiss, MJ, Marques, HP, Aldrighetti, L, Pawlik, TM & He, J 2019, 'The Impact of Extent of Liver Resection Among Patients with Neuroendocrine Liver Metastasis: an International Multi-institutional Study', Journal of Gastrointestinal Surgery, vol. 23, no. 3, pp. 484-491. https://doi.org/10.1007/s11605-018-3862-2
Sham, Jonathan G. ; Ejaz, Aslam ; Gage, Michele M. ; Bagante, Fabio ; Reames, Bradley N ; Maithel, Shishir ; Poultsides, George A. ; Bauer, Todd W. ; Fields, Ryan C. ; Weiss, Matthew J. ; Marques, Hugo Pinto ; Aldrighetti, Luca ; Pawlik, Timothy M. ; He, Jin. / The Impact of Extent of Liver Resection Among Patients with Neuroendocrine Liver Metastasis : an International Multi-institutional Study. In: Journal of Gastrointestinal Surgery. 2019 ; Vol. 23, No. 3. pp. 484-491.
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abstract = "Background: Liver resection in patients with neuroendocrine liver metastasis (NELM) provides a survival benefit, yet the optimal extent of resection remains unknown. We sought to examine outcomes of patients undergoing non-anatomic (NAR) versus anatomic liver resection (AR) for NELM using a large international cohort of patients. Methods: Two hundred and fifty-eight patients who underwent curative intent liver resection from January 1990 to December 2016 were identified from eight institutions. Patients were excluded if they underwent concurrent ablation, had extrahepatic disease, underwent a debulking operation, or had mixed anatomic and non-anatomic resections. Overall (OS) and recurrence-free (RFS) survival were compared among patients based on the extent of liver resection (AR vs. NAR). Results: Most primary tumors were located in the pancreas (n = 117, 45.4{\%}) or the small intestine (n = 65, 25.2{\%}). Liver resection consisted of NAR (n = 126, 48.8{\%}) or AR (n = 132, 51.2{\%}) resection. The overwhelming majority of patients who underwent NAR had an estimated liver involvement of < 50{\%} (NAR 109, 97.3{\%} vs. AR n = 82, 65.6{\%}; P < 0.001). Patients who underwent NAR also had higher rates of primary tumor lymph node metastasis (NAR n = 79, 71.2{\%} vs. AR n = 37, 33.6{\%}; P < 0.001) and microscopically positive margins (R1) (NAR n = 29, 25.7{\%} vs. AR n = 16, 12.5{\%}; P = 0.009). After a median follow-up of 47.7 months, 48 (18.6{\%}) patients died and 37.0{\%} (n = 95) had evidence of disease recurrence. Patients who underwent AR had both longer median OS (not reached) and RFS (not reached) versus patients who underwent NAR (median OS 138.3 months; median RFS 31.3 months) (both P < 0.01). After controlling for patient and disease-related factors, extent of liver resection was independently associated with an increased risk of recurrence (HR 2.39, 95{\%} CI 1.04–5.48; P = 0.04) but not death (HR 1.92, 95{\%} CI 0.40–9.28; P = 0.42). Conclusion: NAR was independently associated with a higher incidence of recurrence versus patients who undergo a formal anatomic hepatectomy among patients with NELM.",
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T1 - The Impact of Extent of Liver Resection Among Patients with Neuroendocrine Liver Metastasis

T2 - an International Multi-institutional Study

AU - Sham, Jonathan G.

AU - Ejaz, Aslam

AU - Gage, Michele M.

AU - Bagante, Fabio

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 Pinto

AU - Aldrighetti, Luca

AU - Pawlik, Timothy M.

AU - He, Jin

PY - 2019/3/15

Y1 - 2019/3/15

N2 - Background: Liver resection in patients with neuroendocrine liver metastasis (NELM) provides a survival benefit, yet the optimal extent of resection remains unknown. We sought to examine outcomes of patients undergoing non-anatomic (NAR) versus anatomic liver resection (AR) for NELM using a large international cohort of patients. Methods: Two hundred and fifty-eight patients who underwent curative intent liver resection from January 1990 to December 2016 were identified from eight institutions. Patients were excluded if they underwent concurrent ablation, had extrahepatic disease, underwent a debulking operation, or had mixed anatomic and non-anatomic resections. Overall (OS) and recurrence-free (RFS) survival were compared among patients based on the extent of liver resection (AR vs. NAR). Results: Most primary tumors were located in the pancreas (n = 117, 45.4%) or the small intestine (n = 65, 25.2%). Liver resection consisted of NAR (n = 126, 48.8%) or AR (n = 132, 51.2%) resection. The overwhelming majority of patients who underwent NAR had an estimated liver involvement of < 50% (NAR 109, 97.3% vs. AR n = 82, 65.6%; P < 0.001). Patients who underwent NAR also had higher rates of primary tumor lymph node metastasis (NAR n = 79, 71.2% vs. AR n = 37, 33.6%; P < 0.001) and microscopically positive margins (R1) (NAR n = 29, 25.7% vs. AR n = 16, 12.5%; P = 0.009). After a median follow-up of 47.7 months, 48 (18.6%) patients died and 37.0% (n = 95) had evidence of disease recurrence. Patients who underwent AR had both longer median OS (not reached) and RFS (not reached) versus patients who underwent NAR (median OS 138.3 months; median RFS 31.3 months) (both P < 0.01). After controlling for patient and disease-related factors, extent of liver resection was independently associated with an increased risk of recurrence (HR 2.39, 95% CI 1.04–5.48; P = 0.04) but not death (HR 1.92, 95% CI 0.40–9.28; P = 0.42). Conclusion: NAR was independently associated with a higher incidence of recurrence versus patients who undergo a formal anatomic hepatectomy among patients with NELM.

AB - Background: Liver resection in patients with neuroendocrine liver metastasis (NELM) provides a survival benefit, yet the optimal extent of resection remains unknown. We sought to examine outcomes of patients undergoing non-anatomic (NAR) versus anatomic liver resection (AR) for NELM using a large international cohort of patients. Methods: Two hundred and fifty-eight patients who underwent curative intent liver resection from January 1990 to December 2016 were identified from eight institutions. Patients were excluded if they underwent concurrent ablation, had extrahepatic disease, underwent a debulking operation, or had mixed anatomic and non-anatomic resections. Overall (OS) and recurrence-free (RFS) survival were compared among patients based on the extent of liver resection (AR vs. NAR). Results: Most primary tumors were located in the pancreas (n = 117, 45.4%) or the small intestine (n = 65, 25.2%). Liver resection consisted of NAR (n = 126, 48.8%) or AR (n = 132, 51.2%) resection. The overwhelming majority of patients who underwent NAR had an estimated liver involvement of < 50% (NAR 109, 97.3% vs. AR n = 82, 65.6%; P < 0.001). Patients who underwent NAR also had higher rates of primary tumor lymph node metastasis (NAR n = 79, 71.2% vs. AR n = 37, 33.6%; P < 0.001) and microscopically positive margins (R1) (NAR n = 29, 25.7% vs. AR n = 16, 12.5%; P = 0.009). After a median follow-up of 47.7 months, 48 (18.6%) patients died and 37.0% (n = 95) had evidence of disease recurrence. Patients who underwent AR had both longer median OS (not reached) and RFS (not reached) versus patients who underwent NAR (median OS 138.3 months; median RFS 31.3 months) (both P < 0.01). After controlling for patient and disease-related factors, extent of liver resection was independently associated with an increased risk of recurrence (HR 2.39, 95% CI 1.04–5.48; P = 0.04) but not death (HR 1.92, 95% CI 0.40–9.28; P = 0.42). Conclusion: NAR was independently associated with a higher incidence of recurrence versus patients who undergo a formal anatomic hepatectomy among patients with NELM.

KW - Anatomic resection

KW - Hepatectomy

KW - Neuroendocrine tumors

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