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Resection Improves Survival

Sandeepa Musunuru, MD; Herbert Chen, MD; Sharad Rajpal, MD; Nicholas Stephani, MD; John C. McDermott, MD; Kyle Holen, MD; Layton F. Rikkers, MD; Sharon M. Weber, MD

Arch Surg. 2006;141:1000-1004.

Background  The optimal treatment for hepatic metastases from neuroendocrine tumors remains controversial because of the often indolent nature of these tumors. We sought to determine the effect of 3 major treatment modalities including medical therapy, hepatic artery embolization, and surgical resection, ablation, or both in patients with liver-only neuroendocrine metastases, with the hypothesis that surgical treatment is associated with improvement in survival.

Design  Retrospective study.

Setting  Tertiary care center.

Patients  Patients with metastatic liver-only neuroendocrine tumors were identified from hospital records.

Interventions  Patients were subdivided into those receiving medical therapy, hepatic artery embolization, or surgical management.

Main Outcome Measures  Effect of treatment on survival and palliation of symptoms was analyzed.

Results  From January 1996 through May 2004, 48 patients with liver-only neuroendocrine metastases were identified (median follow-up, 20 months), including 36 carcinoid and 12 islet cell tumors. Seventeen patients were treated conservatively, which consisted of octreotide (n = 7), observation (n = 6), or systemic chemotherapy (n = 4). Hepatic artery embolization was performed in 18 patients. Thirteen patients underwent surgical therapy, including anatomical liver resection (n = 6), ablation (n = 4), or combined resection and ablation (n = 3). No difference was noted in the percentage of liver involved with tumor between the 3 groups. An association of improved survival was noted in patients treated surgically, with a 3-year survival of 83% for patients treated by surgical resection, compared with 31% in patients treated with medical therapy or embolization (P = .01). No difference in palliation of symptoms was noted among the 3 treatment groups (P = .2).

Conclusion  In patients with liver-only neuroendocrine metastases, surgical therapy using resection, ablation, or both is associated with improved survival.

Author Affiliations: Departments of Surgery (Drs Musunuru, Chen, Rajpal, Rikkers, and Weber), Radiology (Drs Stephani and McDermott), and Medicine (Dr Holen), University of Wisconsin, Madison.

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