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The Impact of Extent of Liver Resection Among Patients with Neuroendocrine Liver Metastasis: an International Multi-institutional Study

2019Journal article Open access
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dc.contributor.authorSham, J
dc.contributor.authorEjaz, A
dc.contributor.authorGage, M
dc.contributor.authorBagante, F
dc.contributor.authorReames, B
dc.contributor.authorMaithel, S
dc.contributor.authorPoultsides, G
dc.contributor.authorBauer, T
dc.contributor.authorFields, R
dc.contributor.authorWeiss, M
dc.contributor.authorPinto Marques, H
dc.contributor.authorAldrighetti, L
dc.contributor.authorPawlik, T
dc.contributor.authorHe, J
dc.date.accessioned2021-10-08T14:50:18Z
dc.date.available2021-10-08T14:50:18Z
dc.date.issued2019
dc.description.abstractBackground: 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.pt_PT
dc.description.versioninfo:eu-repo/semantics/publishedVersionpt_PT
dc.identifier.citationJ Gastrointest Surg. 2019 Mar;23(3):484-491.pt_PT
dc.identifier.doi10.1007/s11605-018-3862-2.pt_PT
dc.identifier.urihttp://hdl.handle.net/10400.17/3872
dc.language.isoengpt_PT
dc.peerreviewedyespt_PT
dc.publisherSpringerpt_PT
dc.subjectHCC CIRpt_PT
dc.subjectAdultpt_PT
dc.subjectAgedpt_PT
dc.subjectFemalept_PT
dc.subjectCohort Studiespt_PT
dc.subjectMalept_PT
dc.subjectHumanspt_PT
dc.subjectMiddle Agedpt_PT
dc.subjectHepatectomy*pt_PT
dc.subjectIntestinal Neoplasms / mortalitypt_PT
dc.subjectIntestinal Neoplasms / pathologypt_PT
dc.subjectIntestinal Neoplasms / therapypt_PT
dc.subjectLiver Neoplasms / mortalitypt_PT
dc.subjectLiver Neoplasms / secondary*pt_PT
dc.subjectLiver Neoplasms / surgery*pt_PT
dc.subjectLymphatic Metastasispt_PT
dc.subjectMargins of Excisionpt_PT
dc.subjectNeoplasm Stagingpt_PT
dc.subjectNeuroendocrine Tumors / mortalitypt_PT
dc.subjectNeuroendocrine Tumors / secondary*pt_PT
dc.subjectNeuroendocrine Tumors / surgery*pt_PT
dc.subjectPancreatic Neoplasms / mortalitypt_PT
dc.subjectPancreatic Neoplasms / pathologypt_PT
dc.subjectPancreatic Neoplasms / therapypt_PT
dc.subjectSurvival Ratept_PT
dc.titleThe Impact of Extent of Liver Resection Among Patients with Neuroendocrine Liver Metastasis: an International Multi-institutional Studypt_PT
dc.typejournal article
dspace.entity.typePublication
oaire.citation.endPage491pt_PT
oaire.citation.startPage484pt_PT
oaire.citation.titleJournal of Gastrointestinal Surgerypt_PT
oaire.citation.volume23pt_PT
rcaap.rightsopenAccesspt_PT
rcaap.typearticlept_PT

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