Medical College of Wisconsin
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Neuroendocrine hepatic metastases: does aggressive management improve survival? Ann Surg 2005 May;241(5):776-83; discussion 783-5

Date

04/26/2005

Pubmed ID

15849513

Pubmed Central ID

PMC1357132

DOI

10.1097/01.sla.0000161981.58631.ab

Scopus ID

2-s2.0-20944445859   265 Citations

Abstract

OBJECTIVE: The aim of this study was to determine whether aggressive management of neuroendocrine hepatic metastases improves survival.

SUMMARY BACKGROUND DATA: Survival in patients with carcinoid and pancreatic neuroendocrine tumors is significantly better than adenocarcinomas arising from the same organs. However, survival and quality of life are diminished in patients with neuroendocrine hepatic metastases. In recent years, aggressive treatment of hepatic neuroendocrine tumors has been shown to relieve symptoms. Minimal data are available, however, to document improved survival with this approach.

METHODS: The records of patients with carcinoid (n = 84) and pancreatic neuroendocrine tumors (n = 69) managed at our institution from January 1990 through July 2004 were reviewed. Eighty-four patients had malignant tumors, and hepatic metastases were present in 60 of these patients. Of these 60 patients, 23 received no aggressive treatment of their liver metastases, 19 were treated with hepatic resection and/or ablation, and 18 were managed with transarterial chemoembolization (TACE) frequently (n = 11) in addition to resection and/or ablation. These groups did not differ with respect to age, gender, tumor type, or extent of liver involvement.

RESULTS: Median and 5-year survival were 20 months and 25% for the Nonaggressive group, >96 months and 72% for the Resection/Ablation group, and 50 months and 50% for the TACE group. The survival for the Resection/Ablation and the TACE groups was significantly better (P < 0.05) when compared with the Nonaggressive group. Patients with more than 50% liver involvement had a poor outcome (P < 0.001).

CONCLUSIONS: These data suggest that aggressive management of neuroendocrine hepatic metastases does improve survival, that chemoembolization increases the patient population eligible for this strategy, and that patients with more than 50% liver involvement may not benefit from an aggressive approach.

Author List

Touzios JG, Kiely JM, Pitt SC, Rilling WS, Quebbeman EJ, Wilson SD, Pitt HA

Author

William S. Rilling MD Vice Chair, Professor in the Radiology department at Medical College of Wisconsin




MESH terms used to index this publication - Major topics in bold

Carcinoid Tumor
Carcinoma, Neuroendocrine
Catheter Ablation
Chemoembolization, Therapeutic
Colorectal Neoplasms
Female
Humans
Liver Neoplasms
Male
Middle Aged
Pancreatic Neoplasms
Retrospective Studies
Survival Analysis
jenkins-FCD Prod-398 336d56a365602aa89dcc112f077233607d6a5abc