Review Article

Multimodal Liver-Directed Management of Neuroendocrine Hepatic Metastases

Table 2

Summary of outcomes from resection of neuroendocrine liver metastases. OS: overall survival; PFS: progression-free survival.

First author, publication yearNo. of surgical patientsMedian followup, monthsSurvival dataPredictors of survival

Mayo, 2011 [30]339 [66 with simultaneous ablation]26Median OS: 123 months 5-year survival: 74%Symptomatic high-volume [>25% liver involved] disease benefited most from surgery (versus intra-arterial therapy, )
Saxena, 2011 [16]74 [38 with simultaneous cryoablation]41Median PFS: 23 monthsWorse PFS with R1 (versus R0) pathologic margin status ( )
Median OS: 95 months Worse OS from higher grade (well versus moderate versus poor differentiation, ) and extrahepatic disease ( )
Karabulut, 2011 [31]27 [excluding subsequent liver transplants]29Median PFS: 15 months Median OS: 190 monthsMargin status did not affect OS; in outcomes analysis including RFA and embolization, worse OS with male gender ( ), dominant metastasis >5 cm (versus <3 cm, ), extrahepatic disease ( )
Glazer, 2010 [32]172 [120 with small bowel or pancreatic primaries; 18 had only RFA]50Median OS: 116 months 5-year survival: 77.4% 10-year survival: 50.4%Increasing time interval from primary resection to hepatic metastases predicted for poorer survival ( )
Sarmiento, 2003 [8]170 [75 with complete resection]Not reported (excluded <12 months followup)Median OS: 81 months 5-year survival: 61% 10-year survival: 35%No OS difference with or without endocrinopathy (60% versus 61% at 5 years, ), no OS difference between carcinoid and islet cell (87 versus 66 months, )
Elias, 2003 [33]47 [36 with concurrent extrahepatic resection]62Median OS: 91 months 5-year survival: 71% 10-year survival: 35%Worse DFS with incomplete surgery (R2 versus R1 versus R0, ), pancreatic origin ( ), bilateral liver involvement ( ); no factor predicted OS
Chen, 1998 [34]15275-year survival: 73% [versus 29% in 23 patients with unresectable disease]Median survival not reached in resection group, but OS significantly longer than unresected ( )