Cytoreductive debulking surgery among patients with neuroendocrine liver metastasis: a multi-institutional analysis

Abstract

Objective: Management of neuroendocrine liver metastasis (NELM) in the setting of unresectable disease is poorly defined and the role of debulking remains controversial. The objective of the current study was to define outcomes following non-curative intent liver-directed therapy among patients with NELM across 8 international institutions. Methods: 612 patients were identified who underwent liver-directed therapy of NELM from a multi-institutional database. Outcomes were stratified according to curative (R0/R1) versus non-curative ≥80% debulking (R2). Results: Ninety-five (15.5%) patients had an R2/debulking procedure. Patients undergoing debulking more commonly had liver disease burden that was bilateral (R0/R1: 57.7% vs. R2: 71.1%; P=0.02) with a subset of patients having >50% involvement of the hepatic parenchyma (R0/R1: 20.8% vs. R2: 19.3%; P=0.18). Over one-quarter of patients who underwent debulking had extra-hepatic disease (R0/R1: 8.7% vs. R2: 26.3%; P<0.001). Patients underwent liver resection alone (R0/R1: 79.1% vs. R2: 65.3%) ablation alone (R0/R1: 2.9% vs. R2: 0%) or a combined approach (R0/R1: 18.0% vs. R2: 34.7%) (P<0.001). After a median follow-up of 51 months, median (R0/R1: not reached vs. R2: 89.2 months; P<0.001) and 5-year survival (R0/R1: 81.9% vs. R2: 58.7%; P<0.001) was higher among patients who underwent an R0/R1 resection compared with patients who underwent a debulking operation. Among patients with >50% NELM liver involvement, median and 5-year survival following debulking was 77.9 months and 53.4%, respectively. Conclusion: Debulking operations for NELM provided reasonable long-term survival. Hepatic debulking for patients with NELM is a reasonable therapeutic option for patients with grossly unresectable disease that may provide a survival benefit.