Hepatic neuroendocrine metastases: Does intervention alter outcomes?

Background: In most instances, advanced neuroendocrine tumors follow an ind olent course. Hepatic metastases are common, and although they can cause si gnificant pain, incapacitating endocrinopathy, and even death, they are usu ally asymptomatic. The appropriate timing and efficacy of interventions, su ch as hepatic artery emobolization (HAE) and operation, remain controversia l. Study Design: The records of 85 selected patients referred for treatment of hepatic neuroendocrine tumor metastases between 1992 and 1998 were reviewe d from a prospective database. A multidisciplinary group of surgeons, radio logists, and oncologists managed all patients. Overall survival among this cohort is reported and prognostic variables, which may be predictive of sur vival, are analyzed. Results: There were 37 men and 48 women, with a median age of 52 years. The re were 41 carcinoid tumors, 26 nonfunctional islet cell tumors, and 18 fun ctional islet cell tumors. Thirty-eight patients had extrahepatic metastase s, and in 84% of patients, the liver metastases were bilobar. Eighteen pati ents were treated with medical therapy or best supportive care, 33 patients underwent HAE, and 34 patients underwent hepatic resection. Both the HAE-r elated mortality and the 30-day operative mortality rates were 6%. By univa riate analysis, earlier resection of the primary tumor, curative intent of treatment, and initial surgical treatment were associated with prolonged su rvival (p < 0.05). On multivariate analysis, only curative intent to treat remained significant (p < 0.04). Patients with bilobar or more than 75% liv er involvement by tumor were least likely to benefit from surgical resectio n. One-, 3-, and 5-year survival rates for the entire group were 83%, 61%, and 53%, respectively. The 1-, 3-, and 5-year survivals for patients treate d with medical therapy, HAE, and operation were 76%, 39%, and not available ; 94%, 83%, and 50%; and 94%, 83%, and 76%, respectively. Conclusions: Hepatic metastases from neuroendocrine tumors are best managed with a multidisciplinary approach. Both HAE and surgical resection provide excellent palliation of hormonal and pain symptoms. In select patients, su rgical resection of hepatic metastases may prolong survival, but is rarely curative. (J Am Coll Surg 2000;190:432-445. (C) 2000 by the American Colleg e of Surgeons).