alexa Surgical resection of hepatic metastases from neuroendocrine neoplasms: a systematic review.


Journal of Gastrointestinal & Digestive System

Author(s): Saxena A, Chua TC, Perera M, Chu F, Morris DL

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Abstract BACKGROUND: Neuroendocrine tumours (NET) most commonly metastasize to the liver. Hepatic resection of NET hepatic metastases (NETHM) has been shown to improve symptomology and survival. METHODS: A systematic review of clinical studies before September 2010 was performed to examine the efficacy of hepatic resection for NETHM. As a secondary end-point, the impact of treatment on safety and symptomology were determined and prognostic variables were identified. The quality of each study was also assessed using predefined criteria incorporating 9 characteristics. Clinical outcome was synthesized through a narrative review with full tabulation of results of all included studies. RESULTS: Twenty-nine included reported survival outcomes with a median 3-, 5- and 10-year overall survival of 83\% (range, 63-100\%), 70.5\% (range, 31-100\%), and 42\% (range, 0-100\%), respectively. The median progression-free survival (PFS) was 21 months (range, 13-46 months) and median 1-,3-,5- and 10-year PFS of 63\% (range, 50-80 \%), 32\% (range, 24-69\%), 29\% (range, 6-66\%) and 1\% (range, 0-11\%), respectively. Poor histologic grade, extra-hepatic disease and a macroscopically incomplete resection were associated with a poor prognosis. Studies reported a median rate of symptomatic relief from surgery in 95\% of patients (range, 50-100\%). CONCLUSION: Hepatic resection for NETHM provides symptomatic benefit and is associated with favourable survival outcomes although the majority of patients invariably develop disease progression. Copyright © 2012 Elsevier Ltd. All rights reserved. This article was published in Surg Oncol and referenced in Journal of Gastrointestinal & Digestive System

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