Both the timing and benefits of hepatectomy remain controversial for metastatic well-differentiated endocrine neoplasms.
These are generally considered to be slow growth tumors, but surveillance alone has a 22% 5-year survival rate.
|Resection was curative in 53% of the patients.|
In this study, researchers from France determined the results of hepatic and extra hepatic resections, and clarified the indications of surgery.
The research team constructed a database regrouping 47 patients who underwent hepatectomy with curative intent for well-differentiated endocrine neoplasms.
They studies new prognostic factors such as tumor growth, and liver tumor mitotic index.
Median follow-up was 62 months.
The research team found that hepatectomy was associated with extrahepatic tumor resection in 77% of the patients.
Resection was curative in 53% of the patients, despite the removal of at least 97% of the tumor in each patient.
The team determined that mortality was 5% and morbidity 45%.
Median survival was 91 months. The researchers calculated 5- and 10-year survival rates to be 71% and 35%, respectively.
Liver recurrence rate was 75% at 10 years.
They did not identify any prognostic factor correlated with overall survival in this population.
However, the completeness of surgery, presence of bilateral liver metastases, number of liver metastases (>10), and a primary tumor from pancreatic origin were all correlated with disease-free survival.
Preoperative tumor growth rate, mitotic index, and Ki67 expression were not found to be predictive of prognosis.
The team failed to identify any prognostic factors by comparing patients who did and did not recur during the 3 years after hepatectomy.
Dr Dominique Elias's team concluded, "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".