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Multicenter Study
. 2019 Jan;23(1):122-134.
doi: 10.1007/s11605-018-3986-4. Epub 2018 Oct 17.

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

Jeffery Chakedis  1 , Eliza W Beal  1 , Alexandra G Lopez-Aguiar  2 , George Poultsides  3 , Eleftherios Makris  3 , Flavio G Rocha  4 , Zaheer Kanji  4 , Sharon Weber  5 , Alexander Fisher  5 , Ryan Fields  6 , Bradley A Krasnick  6 , Kamran Idrees  7 , Paula Marincola-Smith  7 , Clifford Cho  8 , Megan Beems  8 , Timothy M Pawlik  1 , Shishir K Maithel  2 , Carl R Schmidt  1 , Mary Dillhoff  9
Affiliations
Multicenter Study

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

Jeffery Chakedis et al. J Gastrointest Surg. 2019 Jan.

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.

Keywords: Metastatic; Neuroendocrine tumor; Non-hormonal; Palliative surgery; Symptoms.

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Conflict of interest statement

Conflict of Interest The authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
Patient flow diagram
Fig. 2
Fig. 2
Overall survival of patients with metastatic neuroendocrine tumor patients by symptomatology, n = 581. Table shows the number at risk every 2 years
Fig. 3
Fig. 3
Overall survival of metastatic neuroendocrine tumor patients with non-hormonal symptoms, n = 332. a By operation intent. b By specific non-hormonal symptoms
Fig. 4
Fig. 4
Overall survival of metastatic neuroendocrine tumor patients with non-hormonal symptoms, n = 332. a By tumor grade. b By tumor differentiation
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References

    1. Frilling A, Modlin IM, Kidd M, et al. Recommendations for management of patients with neuroendocrine liver metastases. Lancet Oncol. 2014;15(1):e8–21. - PubMed
    1. Pavel M, O’Toole D, Costa F, et al. ENETS Consensus Guidelines Update for the Management of Distant Metastatic Disease of Intestinal, Pancreatic, Bronchial Neuroendocrine Neoplasms (NEN) and NEN of Unknown Primary Site. Neuroendocrinology. 2016;103(2):172–185. - PubMed
    1. Boudreaux JP, Klimstra DS, Hassan MM, et al. The NANETS consensus guideline for the diagnosis and management of neuroendocrine tumors: well-differentiated neuroendocrine tumors of the Jejunum, Ileum, Appendix, and Cecum. Pancreas. 2010;39(6): 753–766. - PubMed
    1. Rinke A, Muller HH, Schade-Brittinger C, et al. Placebo-controlled, double-blind, prospective, randomized study on the effect of octreotide LAR in the control of tumor growth in patients with metastatic neuroendocrine midgut tumors: a report from the PROMID Study Group. J Clin Oncol. 2009;27(28):4656–4663. - PubMed
    1. Caplin ME, Pavel M, Cwikla JB, et al. Lanreotide in metastatic enteropancreatic neuroendocrine tumors. N Engl J Med. 2014;371(3):224–233. - PubMed

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