Surgical and oncologic outcomes for liver resections of cystic neuroendocrine tumor liver metastasis.

Autor: Ammann M; Department of Surgery, Division of Hepatobiliary and Pancreas Surgery, Mayo Clinic, Rochester, MN, USA; Department of Surgery, State Hospital Wiener Neustadt, Wiener Neustadt, Austria., Adjei Antwi SK; Department of Surgery, Division of Hepatobiliary and Pancreas Surgery, Mayo Clinic, Rochester, MN, USA; Department of Surgery, University Milano-Bicocca, Minao, Italy., Gudmundsdottir H; Department of Surgery, Division of Hepatobiliary and Pancreas Surgery, Mayo Clinic, Rochester, MN, USA; Division of Health Care Delivery Research, Robert D. and Patricia E. Kern Center for Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA., Hackl H; Institute of Bioinformatics, Biocenter, Medical University of Innsbruck, Innsbruck, Austria., Santol J; Department of Surgery, Division of Hepatobiliary and Pancreas Surgery, Mayo Clinic, Rochester, MN, USA; Department of Surgery, HPB Center, Vienna Health Network, Clinic Favoriten and Sigmund Freud Private University, Vienna, Austria., Guillot BE; Department of Surgery, Division of Hepatobiliary and Pancreas Surgery, Mayo Clinic, Rochester, MN, USA., Pappalettera G; Department of Surgery, Division of Hepatobiliary and Pancreas Surgery, Mayo Clinic, Rochester, MN, USA., Thiels CA; Department of Surgery, Division of Hepatobiliary and Pancreas Surgery, Mayo Clinic, Rochester, MN, USA., Warner SG; Department of Surgery, Division of Hepatobiliary and Pancreas Surgery, Mayo Clinic, Rochester, MN, USA., Truty MJ; Department of Surgery, Division of Hepatobiliary and Pancreas Surgery, Mayo Clinic, Rochester, MN, USA., Kendrick ML; Department of Surgery, Division of Hepatobiliary and Pancreas Surgery, Mayo Clinic, Rochester, MN, USA., Smoot RL; Department of Surgery, Division of Hepatobiliary and Pancreas Surgery, Mayo Clinic, Rochester, MN, USA., Nagorney DM; Department of Surgery, Division of Hepatobiliary and Pancreas Surgery, Mayo Clinic, Rochester, MN, USA., Cleary SP; Department of Surgery, Division of Hepatobiliary and Pancreas Surgery, Mayo Clinic, Rochester, MN, USA; Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Canada., Halfdanarson TR; Division of Medical Oncology, Department of Oncology, Mayo Clinic, Rochester, MN, USA., Starlinger PP; Department of Surgery, Division of Hepatobiliary and Pancreas Surgery, Mayo Clinic, Rochester, MN, USA. Electronic address: starlinger.patrick@mayo.edu.
Jazyk: angličtina
Zdroj: European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology [Eur J Surg Oncol] 2024 Nov 15, pp. 109464. Date of Electronic Publication: 2024 Nov 15.
DOI: 10.1016/j.ejso.2024.109464
Abstrakt: Background: Cystic neuroendocrine tumor liver metastases (NETLM) are rare and dynamics in the liquid compartment often misinterpreted as rapid progression, affecting selection for liver resection candidates. This study retrospectively evaluates surgical and oncologic outcomes in patients with cystic versus solid NETLM from small bowel and pancreatic primaries.
Methods: Between 2000 and 2020, 12 patients with cystic NETLM were identified among 464 patients who underwent >90 % tumor cytoreduction debulking hepatectomy at the Mayo Clinic. Tumor and patient characteristics, as well as surgical and oncologic outcomes, were compared with the total cohort of patients with solid NETLM, including a propensity-matched cohort.
Results: Patients with cystic NETLM were similar in age (55.4 vs. 59.7 years; p = 0.113) and sex (58 % vs. 51 % men; p = 0.772) to those with solid NETLM. Synchronous metastases (92 % vs. 77 %; p = 0.314), bilobar distribution (83 % vs. 79 %; p = 1.000), lesion numbers (p = 0.547), Ki67 % expression (p = 0.311), and extrahepatic lesions (8 % vs. 18 %; p = 0.702) were similar. Cystic metastases were larger (7.3 vs. 3.8 cm; p < 0.001). Surgical risk did not differ, with major morbidity (25 % vs. 22 %; p = 0.729) and mortality (0 % vs. <2 %; p = 1.000). Median overall survival (OS) was 13.8 vs. 10.6 years (p = 0.513), and hepatic-progression-free survival (PFS) was 0.71 vs. 1.78 years (p = 0.507). Matched cohorts showed no significant difference in OS (13.80 vs. 8.57; p = 0.316) or hepatic-PFS (0.71 vs. 1.33; p = 0.620).
Conclusion: Surgical risk and long-term outcomes do not significantly differ between cystic and solid NETLMs. Given excellent long-term survival rates with >90 % cytoreduction, radical debulking is advised for both phenotypes when clinically feasible.
Competing Interests: Declaration of interest Thorvardur R. Halfdanarson: served on the consulting/advisory board for Ipsen, TerSera, ScioScientifc, Curium, Advanced Accelerator Applications (a Novartis company), Terumo, ITM Isotopen Technologien Muenchen, Perspective Therapeutics, Abdera Therapeutics, Exelixis, Camurus and Crinetics. Dr. Halfdanardson received research support from Thermo Fisher Scientific, Advanced Accelerator Applications (a Novartis company), Camurus, Crinetics, ITM Isotopen Technologien Muenchen, and Perspective Therapeutics. All other authors: none.
(Copyright © 2024 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.)
Databáze: MEDLINE
Externí odkaz: