Surgery versus intra-arterial therapy for neuroendocrine liver metastasis: a multicenter international analysis.

Published

Journal Article

BACKGROUND: Management of patients with neuroendocrine liver metastasis (NELM) remains controversial. We sought to examine the relative efficacy of surgical management versus intra-arterial therapy (IAT) for NELM and determine factors predictive of survival. METHODS: A total of 753 patients who had surgery (n = 339) or IAT (n = 414) for NELM from 1985 to 2010 were identified from nine hepatobiliary centers. Clinicopathologic data were assessed with regression modeling and propensity score matching. RESULTS: Most patients had a pancreatic (32%) or a small bowel (27%) primary tumor; 47% had a hormonally active tumor. There were statistically significant differences in characteristics between surgery versus IAT groups (hormonally active tumors: 28 vs. 48%; hepatic tumor burden >25%: 52% vs. 76%) (all P < 0.001). Among surgical patients, most underwent hepatic resection alone without ablation (78%). The median number of IAT treatments was 1 (range, 1-4). Median and 5-year survival of patients treated with surgery was 123 months and 74% vs. 34 months and 30% for IAT (P < 0.001). In the propensity-adjusted multivariate Cox model, asymptomatic disease (hazard ratio 2.6) was strongly associated with worse outcome (P = 0.001). Although surgical management provided a survival benefit over IAT among symptomatic patients with >25% hepatic tumor involvement, there was no difference in long-term outcome after surgery versus IAT among asymptomatic patients (P = 0.78). CONCLUSIONS: Asymptomatic patients with a large (>25%) burden of liver disease benefited least from surgical management and IAT may be a more appropriate treatment strategy. Surgical management of NELM should be reserved for patients with low-volume disease or for those patients with symptomatic high-volume disease.

Full Text

Cited Authors

  • Mayo, SC; de Jong, MC; Bloomston, M; Pulitano, C; Clary, BM; Reddy, SK; Clark Gamblin, T; Celinski, SA; Kooby, DA; Staley, CA; Stokes, JB; Chu, CK; Arrese, D; Ferrero, A; Schulick, RD; Choti, MA; Geschwind, J-FH; Strub, J; Bauer, TW; Adams, RB; Aldrighetti, L; Mentha, G; Capussotti, L; Pawlik, TM

Published Date

  • December 2011

Published In

Volume / Issue

  • 18 / 13

Start / End Page

  • 3657 - 3665

PubMed ID

  • 21681380

Pubmed Central ID

  • 21681380

Electronic International Standard Serial Number (EISSN)

  • 1534-4681

International Standard Serial Number (ISSN)

  • 1068-9265

Digital Object Identifier (DOI)

  • 10.1245/s10434-011-1832-y

Language

  • eng