Pancreatic neuroendocrine tumors (PNETs) present in more than 50% of cases with liver metastases as the only systemic localization. Liver metastases are unresectable in 80% of cases at diagnosis. In the context of a metastatic disease, the benefit of primary tumor removal in terms of survival is controversial.
A single-center series of patients with PNETs presenting with synchronous unresectable hepaticmetastases and treated within a framework of a multidisciplinary team was analyzed retrospectively to assess the prognostic factors and the potential benefit of primary tumor resection on long-term survival.
At the time of diagnosis, 12 of 43 patients (28%) underwent primary tumor resection. After a median follow-up of 5 years (range, 0.6–14 years), 22 disease-related deaths were observed. The corresponding 5-year survival and median disease-specific duration of survival were 58% and 77 months, respectively. In the operated and nonoperated patients the 5-year disease-specific survival was 82% and 50%, respectively (P = .027). At multivariate analysis, patients with primary tumor removed had an improved survival compared with patients who did not (hazard ratio 0.18; 95% CI 0.05–0.66; P = .010). Other important factors associated with improved survival at multivariate analysis were lesser age, lesser Ki-67 index, and 25% less liver tumor burden.
In the present series of patients with PNETs and unresectable liver metastases, resection of the primary tumor was associated with an improved survival. This observation suggests that resection of the primary tumor should be part of a global therapeutic strategy and its indication and timing should be discussed within a multidisciplinary team.
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to Surgery
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- Population-based study of islet cell carcinoma.Ann Surg Oncol. 2007; 14: 3492-3500
- Hepatic neuroendocrine metastases: does intervention alter outcomes?.J Am Coll Surg. 2000; 190: 432-445
- Nonfunctional pancreatic islet cell tumors.in: Doherty G. Skogseid B. Surgical endocrinology. 1st ed. Lippincott Williams & Wilkins, Philadelphia2001: 361-373
- Prognostic factors and survival in endocrine tumor patients: comparison between gastrointestinal and pancreatic localization.Endocr Relat Cancer. 2005; 12: 1083-1092
- Aggressive surgery for metastatic liver neuroendocrine tumors.Surgery. 2003; 134: 1057-1065
- Concurrent resections of pancreatic islet cell cancers with synchronous hepatic metastases: outcomes of an aggressive approach.Surgery. 2002; 132: 976-983
- Clinical and imaging followup after exhaustive liver resection of endocrine metastases: a 15-year monocentric experience.Endocr Relat Cancer. 2009; 16: 977-990
- Cytoreductive hepatic surgery for neuroendocrine tumors.Surgery. 1990; 108: 1091-1096
- Clinical characteristics, treatment and survival in patients with pancreatic tumors causing hormonal syndromes.World J Surg. 1992; 16: 632-639
- Primary tumour resection in metastatic nonfunctioning pancreatic endocrine carcinomas.Dig Liver Dis. 2009; 41: 49-55
- Role of resection of the primary pancreatic neuroendocrine tumour only in patients with unresectable metastatic liver disease: a systematic review.Neuroendocrinology. 2011; 93: 223-229
- Barcelona Consensus Conferencearticipants. ENETS Consensus Guidelines for the management of patients with digestive neuroendocrine neoplasms: functional pancreatic endocrine tumor syndromes.Neuroendocrinology. 2012; 95: 98-119
- ENETS Consensus Guidelines for the management of patients with digestive neuroendocrine neoplasms of the digestive system: well-differentiated pancreatic non-functioning tumors.Neuroendocrinology. 2012; 95: 120-134
- NANETS treatment guidelines: well-differentiated neuroendocrine tumors of the stomach and pancreas.Pancreas. 2010; 39: 735-752
- Neuroendocrine tumors.J Natl Compr Canc Netw. 2012; 10: 724-764
- Nomenclature and classification of neuroendocrine neoplasm of the digestive system.in: Bosman F.T. Carneiro F. Hruban R.H. WHO classification of tumor of the digestive system. International Agency for Research on Cancer (IRAC), Lyon2010: 13-14
- pancreatic endocrine tumors: improve TNM staging and histopathological grading permit a clinically efficient prognostic stratification of patients.Mod Pathol. 2010; 26: 824-833
- Nonfunctioning islet cell carcinoma of the pancreas: survival results in a contemporary series of 163 patients.Surgery. 2001; 130: 1078-1085
- Surgery in malignant pancreatic neuroendocrine tumors.J Surg Oncol. 2007; 96: 397-403
- Gastroenteropancreatic neuroendocrine tumors.Lancet Oncol. 2008; 9: 61-62
- A rationale for multidisciplinary care in treating neuroendocrine tumours.Curr Opin Endocrinol Diabetes Obes. 2012; 19: 306-313
- Radiolabeled somatostatin analog [177Lu-DOTA0,Tyr3]octreotate in patients with endocrine gastroenteropancreatic tumors.J Clin Oncol. 2005; 23: 2754-2762
Published online: December 26, 2013
Accepted: December 19, 2013
© 2014 Mosby, Inc. Published by Elsevier Inc. All rights reserved.