Retrospective Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Apr 27, 2020; 12(4): 159-170
Published online Apr 27, 2020. doi: 10.4240/wjgs.v12.i4.159
Contemporary indications for and outcomes of hepatic resection for neuroendocrine liver metastases
Steven D Scoville, Dimitrios Xourafas, Aslam M Ejaz, Allan Tsung, Timothy Pawlik, Jordan M Cloyd
Steven D Scoville, Dimitrios Xourafas, Aslam M Ejaz, Allan Tsung, Timothy Pawlik, Jordan M Cloyd, Department of Surgery, Division of Surgical Oncology at The Ohio State University, James Cancer Center, Columbus, OH 43210, United States
Steven D Scoville, The Arthur G James Comprehensive Cancer Center and Solove Research Institute, The Ohio State University, Columbus, OH 43210, United States
Dimitrios Xourafas, Department of Surgery, Harvard Medical School, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02215, United States
Aslam M Ejaz, Timothy Pawlik, Jordan M Cloyd, Department of Surgery, The Ohio State University, Columbus, OH 43210, United States
Allan Tsung, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH 43210, United States
Jordan M Cloyd, Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center, Columbus, OH 43210, United States
Author contributions: All authors helped to perform the research; Scoville SD, Xourafas D and Cloyd JM performed drafting conception and design, data analysis, manuscript writing; Ejaz AM, Tsung A and Pawlik T contributed to writing the manuscript.
Institutional review board statement: Not applicable as data was de-identified and publicly available.
Informed consent statement: Not applicable as data was de-identified and publicly available.
Conflict-of-interest statement: We have no financial relationships to disclose.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Jordan M Cloyd, MD, Assistant Professor, Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center, 410 W 10th Ave, N-907 Doan Hall, Columbus, OH 43210, United States. jordan.cloyd@osumc.edu
Received: November 21, 2019
Peer-review started: November 21, 2019
First decision: December 13, 2019
Revised: February 21, 2020
Accepted: March 5, 2020
Article in press: March 5, 2020
Published online: April 27, 2020
Processing time: 154 Days and 7.2 Hours
Abstract
BACKGROUND

Although surgical resection is associated with the best long-term outcomes for neuroendocrine liver metastases (NELM), the current indications for and outcomes of surgery for NELM from a population perspective are not well understood.

AIM

To determine the current indications for and outcomes of liver resection (LR) for NELM using a population-based cohort.

METHODS

A retrospective review of the 2014-2017 American College of Surgeons National Surgical Quality Improvement Program and targeted hepatectomy databases was performed to identify patients who underwent LR for NELM. Perioperative characteristics and 30-d morbidity and mortality were analyzed.

RESULTS

Among 669 patients who underwent LR for NELM, the median age was 60 (interquartile range: 51-67) and 51% were male. While the number of metastases resected ranged from 1 to 9, the most common (45%) number of tumors resected was one. The majority (68%) of patients had a largest tumor size of < 5 cm. Most patients underwent partial hepatectomy (71%) while fewer underwent a right or left hepatectomy or trisectionectomy. The majority of operations were open (82%) versus laparoscopic (17%) or robotic (1%). In addition, 30% of patients underwent intraoperative ablation while 45% had another concomitant operation including cholecystectomy (28.8%), bowel resection (20.2%), or partial pancreatectomy (3.4%). Overall 30-d morbidity and mortality was 29% and 1.3%, respectively. On multivariate analysis, American Society of Anesthesiologists class ≥ 3 [odds ratios (OR), OR = 2.089, 95% confidence intervals (CI): 1.197-3.645], open approach (OR = 1.867, 95%CI: 1.148-3.036), right hepatectomy (OR = 1.618, 95%CI: 1.014-2.582), and prolonged operative time of > 230 min (OR = 1.731, 95%CI: 1.168-2.565) were associated with higher 30-d morbidity while intraoperative ablation and concomitant procedures were not.

CONCLUSION

LR for NELM was performed with relatively low postoperative morbidity and mortality. Concomitant procedures performed at the time of LR did not increase morbidity.

Keywords: Carcinoid; Neuroendocrine tumor; Primary tumor resection; Intraoperative ablation; Cholecystectomy; Small bowel resection

Core tip: Surgical resection of neuroendocrine liver metastases is associated with the best long-term outcomes, however the current indications for and outcomes of surgery are not well understood. In this study, we performed a retrospective review of the 2014-2017 American College of Surgeons National Surgical Quality Improvement Program to identify 669 patients who underwent liver resection to define characteristics associated with increased 30-d postoperative morbidity and mortality. Overall morbidity and mortality were relatively low at 29% and 1.3% respectively. Factors associated with increased 30-d morbidity included open and prolonged cases (> 230 min), right hepatectomy, and American Society of Anesthesiologists class ≥ 3 while concomitant procedures including intraoperative ablation did not influence morbidity.