Surgery Provides Long-Term Survival in Patients with Metastatic Neuroendocrine Tumors Undergoing Resection for Non-Hormonal Symptoms

• Type of Material: Article
• Authors: Jeffrey Chakedis, Ohio State University; Eliza W Beal, Ohio State University; Alexandra G Lopez-Aguiar, Emory University; George Poultsides, Stanford University; Eleftherios Makris, Stanford University; Flavio G Rocha, Virginia Mason Medical Center; Zaheer Kanji, Virginia Mason Medical Center; Sharon Weber, University of Wisconsin; Alexander Fisher, University of Wisconsin; Ryan Fields, Washington University; Bradley A Krasnick, Washington University; Kamran Idrees, Vanderbilt University; Paula Marincola-Smith, Vanderbilt University; Clifford Cho, University of Michigan; Megan Beems, University of Michigan; Timothy M Pawlik, Ohio State University; Shishir Maithel, Emory University; Carl R Schmidt, Ohio State University; Mary Dillhoff, Ohio State University
• Language: English
• Date: 2019-01-01
• Publisher: SPRINGER
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2018 Society for Surgery of the Alimentary Tract. Published by ELSEVIER INC. All rights reserved.
• Final Published Version (URL): http://dx.doi.org/10.1007/s11605-018-3986-4
• Title of Journal or Parent Work: JOURNAL OF GASTROINTESTINAL SURGERY
• Volume: 23
• Issue: 1
• Start Page: 122
• End Page: 134
• Keywords: CYTOREDUCTIVE SURGERY; Symptoms; Non-hormonal; Metastatic; Gastroenterology & Hepatology; LIVER METASTASES; PROGNOSTIC-FACTORS; Palliative surgery; Science & Technology; QUALITY-OF-LIFE; Surgery; LU-177-DOTATATE; Life Sciences & Biomedicine; CANCER; POSTOPERATIVE COMPLICATIONS; MESENTERIC METASTASES; SURGICAL-MANAGEMENT; DIAGNOSIS; Neuroendocrine tumor

Abstract

Introduction: Patients with metastatic neuroendocrine tumor (NET) often have an indolent disease course yet the outcomes for patients with metastatic NET undergoing surgery for non-hormonal (NH) symptoms of GI obstruction, bleeding, or pain is not known. Methods: We identified patients with metastatic gastroenteropancreatic NET who underwent resection from 2000 to 2016 at 8 academic institutions who participated in the US Neuroendocrine Tumor Study Group. Results: Of 581 patients with metastatic NET to liver (61.3%), lymph nodes (24.1%), lung (2.1%), and bone (2.5%), 332 (57.1%) presented with NH symptoms of pain (n = 223, 67.4%), GI bleeding (n = 54, 16.3%), GI obstruction (n = 49, 14.8%), and biliary obstruction (n = 22, 6.7%). Most patients were undergoing their first operation (85.4%) within 4 weeks of diagnosis. The median overall survival was 110.4 months, and operative intent predicted survival (p < 0.001) with 66.3% undergoing curative resection. Removal of all metastatic disease was associated with the longest median survival (112.5 months) compared to debulking (89.2 months), or palliative resection (50.0 months; p < 0.001). The 1-, 3-, and 12-month mortality was 3.0%, 4.5%, and 9.0%, respectively. Factors associated with 1-year mortality included palliative operations (OR 6.54, p = 0.006), foregut NET (5.62, p = 0.042), major complication (4.91, p = 0.001), and high tumor grade (11.2, p < 0.001). The conditional survival for patients who lived past 1 year was 119 months. Conclusions: Patients with metastatic NET and NH symptoms that necessitate surgery have long-term survival, and goals of care should focus on both oncologic and quality of life impact. Surgical intervention remains a critical component of multidisciplinary care of symptomatic patients.