Background: The presence of liver metastases is a poor prognostic factor in patients with Neuroendocrine tumours (NET). Resection of NET liver metastases (NET mets) has been reported to be associated with good long-term outcomes but must be balanced against the risks of major surgery. Thermal ablation or arterial embolisation offers an alternative to surgery.
Objective: To review the outcomes of radical treatment of NET mets.
Materials and methods: Data was collected retrospectively between 1998 to 2016 of consecutive patients with NET mets who underwent radical treatment (surgical resection, radiofrequency ablation (RFA) and/or trans-arterial embolisation (TAE)) in a single specialist HPB/NET centre.
Results: Fifty-four patients (38.9% male) were included. Median age at treatment was 55 years (range: 1478). Twenty-one (38.9%) patients had a pancreatic primary NET tumour, 24 (44.4%) in the midgut and 9 (16.7%) in other locations. Forty-four patients had a previous operation for primary tumor resection. Radical therapy consisted of surgical resection in 41 (75.9%), TAE in 5 (9.3%), RFA in 2 (3.7%) and 1 (1.8%) underwent liver transplant. Five (9.3%) patients underwent surgical resection and simultaneous intra-operative RFA. Seventeen (31.5%) patients had low-grade, 21 (38.9%) had intermediate-grade and 8 (14.8%) had high-grade liver metastases and in 8 the grade was not defined. Those with high-grade tumour had a significantly shorter survival. Median follow-up period was 49 months (range: 1172). Progression occurred in 50% of patients. Median progression-free survival (PFS) was 14.5 months (range: 0120). Forty of the 54 patients (74.0%) were alive at last follow-up. Median overall survival (OS) was 41 months (range: 0140).
Conclusion: In this single center experience, liver resection has been the main form of radical therapy for NET mets despite RFA and TAE being available throughout this period. Although progression occurred in 50%, 74% of patients were alive at median follow-up of over 4 years supporting a radical approach for selected patients with NET mets.
04 Dec 2017
UK and Ireland Neuroendocrine Tumour Society