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Abstract
to determine the prognostic factors that may impact on morbidity and mortality and survival of patients undergoing surgical treatment of liver metastases from neuroendocrine tumors. We studied 22 patients undergoing liver resection for metastases from neuroendocrine tumors between 1997 and 2007. Epidemiological and clinical data were correlated with morbidity and mortality and overall and disease-free survivals. twelve patients were male and ten female, with a mean age of 48.5 years. Bilobar disease was present in 17 patients (77.3%). In ten patients (45.5%) the primary tumor originated in the pancreas, terminal ileum in eight, duodenum in two, rectum in one and jejunum in one. Complete surgical resection (R0) was achieved in 59.1% of patients. Eight patients (36.3%) developed complications in the immediate postoperative period, one of them dying from septicemia. All patients undergoing re-hepatectomy and/or two-stage hepatectomy had complications in the postoperative period. The overall survival at one and five years was 77.3% and 44.2%. The disease-free survival at five years was 13.6%. The primary pancreatic neuroendocrine tumor (p = 0.006) was associated with reduced overall survival. Patients with number of metastatic nodules < 10 (p = 0.03) and asymptomatic at diagnosis (p = 0.015) had higher disease-free survival. liver metastases originating from pancreatic neuroendocrine tumors proved to be a negative prognostic factor. Symptomatic patients with multiple metastatic nodules showed a significant reduction in disease-free survival.
Highlights
Neuroendocrine tumors (NETs) are a heterogeneous and unusual group of neoplasms, with variable natural history, slow-growing and often indolent evolution
The liver is the organ which is most affected by distant metastases and it is estimated that 75% of patients with small bowel TNE and 30% to 85% of those with TNE of pancreatic origin develop liver metastases, of whom 80% die within five years[3,5]
This study aims to determine the prognostic factors that may impact mortality, morbidity and survival of patients undergoing surgical treatment of liver metastases from neuroendocrine tumors
Summary
Neuroendocrine tumors (NETs) are a heterogeneous and unusual group of neoplasms, with variable natural history, slow-growing and often indolent evolution. They are characterized by the ability to synthesize, store and secrete hormonal substances and vasoactive amines, which are directly related to clinical manifestations[1]. The exact incidence of neuroendocrine tumors is variable between different studies, involving 1-7 cases / 100,000 individuals[2], representing 0.49% of all cancers[3]. Neuroendocrine tumors are generally indolent, slow-growing compared to carcinomas, metastases can occur, making the prognosis poor. Neuroendocrine tumors series show that 17% to 27% haveregional disease, and 17% to 74%, distant metastatic involvement 1. The liver is often the only organ affected by distant metastases[6]. The TNE fiveyear survival in the presence of liver metastases ranges from 13% to 35%5,7-9 , and from 77% to 99% in the absence of hepatic involvement[2]
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