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. 2023 Mar 29;15(7):2048.
doi: 10.3390/cancers15072048.

Surgical Approach to Liver Metastases in GEP-NET in a Tertiary Reference Center

Frederike Butz  1 , Agata Dukaczewska  1 , Henning Jann  2 , Eva Maria Dobrindt  1 , Lisa Reinhard  1 , Georg Lurje  1 , Johann Pratschke  1 , Peter E Goretzki  1 , Wenzel Schöning  1 , Martina T Mogl  1
Affiliations

Surgical Approach to Liver Metastases in GEP-NET in a Tertiary Reference Center

Frederike Butz et al. Cancers (Basel). .

Abstract

Indications for liver resection in patients with gastroenteropancreatic neuroendocrine tumors (GEP-NET) vary from liver resection with curative intent to tumor debulking or tissue sampling for histopathological characterization. With increasing expertise, the number of minimally invasive liver surgeries (MILS) in GEP-NET patients has increased. However, the influence on the oncological outcome has hardly been described. The clinicopathological data of patients who underwent liver resection for hepatic metastases of GEP-NET at the Department of Surgery, Charité-Universitätsmedizin Berlin, were analyzed. Propensity score matching (PSM) was performed to compare MILS with open liver surgery (OLS). In total, 22 patients underwent liver surgery with curative intent, and 30 debulking surgeries were analyzed. Disease-free survival (DFS) was longer than progression-free survival (PFS) (10 vs. 24 months), whereas overall survival (OS) did not differ significantly (p = 0.588). Thirty-nine (75%) liver resections were performed as OLS, and thirteen (25%) as MILS. After PSM, a shorter length of hospital stay was found for the MILS group (14 vs. 10 d, p = 0.034), while neither DFS/PFS nor OS differed significantly. Both curative intended and cytoreductive resection of hepatic GEP-NET metastases achieved excellent outcomes. MILS led to a reduced length of hospital, while preserving a good oncological outcome.

Keywords: debulking surgery; laparoscopic liver surgery; minimally invasive liver surgery; neuroendocrine liver metastases.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
The grading of (a) primary tumor and (b) hepatic metastases differed significantly according to the localization of the primary tumor; (c) patients undergoing liver-directed surgery for NELM faced a relatively good prognosis, with an exemplary 2-year overall survival rate of 93% calculated with the Kaplan–Meier method; * = 0.05 ≥ p ≥ 0.01; ** = 0.01 > p ≥ 0.001.
Figure 2
Figure 2
(a) Disease-free survival in patients undergoing curative intended liver-directed surgery for NELM, (b) progression-free survival in patients undergoing debulking surgery for NELM and (c) overall survival of patients who underwent liver-directed surgery for NELM comparing the indications for surgery calculated with the Kaplan–Meier method. No significant difference was demonstrated in OS (p = 0.588); C, Curative; D, Debulking.
Figure 2
Figure 2
(a) Disease-free survival in patients undergoing curative intended liver-directed surgery for NELM, (b) progression-free survival in patients undergoing debulking surgery for NELM and (c) overall survival of patients who underwent liver-directed surgery for NELM comparing the indications for surgery calculated with the Kaplan–Meier method. No significant difference was demonstrated in OS (p = 0.588); C, Curative; D, Debulking.
Figure 3
Figure 3
(a) Disease-/progression-free survival and (b) overall survival of patients who underwent liver-directed surgery for NELM comparing minimally invasive and open liver surgery, calculated with the Kaplan–Meier method. Neither DFS/PFS nor OS differed significantly between MILS and OLS (p = 0.816 and p = 0.483) groups. MILS, minimally invasive liver surgery; OLS, open liver surgery.
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