Ostapenko A, Stroever S, Eyasu L, Kim M, Aploks K, Dong XD, Seshadri R. Role of ablation therapy in conjunction with surgical resection for neuroendocrine tumors involving the liver. World J Gastrointest Surg 2024; 16(3): 768-776 [PMID: 38577070 DOI: 10.4240/wjgs.v16.i3.768]
Corresponding Author of This Article
Alexander Ostapenko, MD, Doctor, Department of General Surgery, Danbury Hospital, No. 24 Hospital Ave, Danbury, CT 06810, United States. sashaostapenko27@gmail.com
Research Domain of This Article
Surgery
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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/
World J Gastrointest Surg. Mar 27, 2024; 16(3): 768-776 Published online Mar 27, 2024. doi: 10.4240/wjgs.v16.i3.768
Role of ablation therapy in conjunction with surgical resection for neuroendocrine tumors involving the liver
Alexander Ostapenko, Stephanie Stroever, Lud Eyasu, Minha Kim, Krist Aploks, Xiang Da Dong, Ramanathan Seshadri
Alexander Ostapenko, Lud Eyasu, Minha Kim, Krist Aploks, Department of General Surgery, Danbury Hospital, Danbury, CT 06810, United States
Stephanie Stroever, Department of Research and Innovation, Nuvance Health, Danbury, CT 06810, United States
Xiang Da Dong, Ramanathan Seshadri, Division of Surgical Oncology/Hepato-Pancreato-Biliary Surgery, Danbury Hospital, Danbury, CT 06810, United States
Author contributions: Ostapenko A designed and performed the research and wrote the paper; Seshadri R designed the research and supervised the report; Stroever S designed the research and contributed to the analysis; Eyasu L, Kim M, Aploks K, Dong XD provided clinical advice.
Institutional review board statement: Ethical review and approval was not required for this study since the data used was de-identified and obtained from a participant use file.
Informed consent statement: This study is retrospective review that utilized only de-identified patient data from the American College of Surgeons National Surgical Quality Improvement Program.
Conflict-of-interest statement: The authors have no conflicts of interest to declare.
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: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Alexander Ostapenko, MD, Doctor, Department of General Surgery, Danbury Hospital, No. 24 Hospital Ave, Danbury, CT 06810, United States. sashaostapenko27@gmail.com
Received: December 17, 2023 Peer-review started: December 17, 2023 First decision: January 10, 2024 Revised: January 13, 2024 Accepted: February 5, 2024 Article in press: February 5, 2024 Published online: March 27, 2024 Processing time: 95 Days and 16.5 Hours
Abstract
BACKGROUND
Resection of hepatic metastasis from neuroendocrine tumors (NETs) improves quality of life and prolongs 5-year survival. Ablation can be utilized with surgery to achieve complete resection. Although several studies report long-term outcomes for patients undergoing ablation, none have explored perioperative effects of ablation in patients with metastatic NETs.
AIM
To determine if intra-operative ablation during hepatectomy increases risk of adverse outcomes such as surgical site infections (SSIs), bleeding, and bile leak.
METHODS
A retrospective analysis of the hepatectomy National Surgical Quality Improvement Program database from 2015-2019 was performed to determine the odds of SSIs, bile leaks, or bleeding in patients undergoing intraoperative ablation when compared to hepatectomy alone.
RESULTS
Of the 966 patients included in the study, 298 (30.9%) underwent ablation during hepatectomy. There were 78 (11.7%) patients with SSIs in the hepatectomy alone group and 39 (13.1%) patients with a SSIs in the hepatectomy with ablation group. Bile leak occurred in 41 (6.2%) and 14 (4.8%) patients in the two groups, respectively; bleeding occurred in 117 (17.5%) and 33 (11.1%), respectively. After controlling for confounding variables, ablation did not increase risk of SSI (P = 0.63), bile leak (P = 0.34) or bleeding (P = 0.07) when compared to patients undergoing resection alone on multivariate analysis.
CONCLUSION
Intraoperative ablation with hepatic resection for NETs is safe in the perioperative period without significant increased risk of infection, bleeding, or bile leak. Surgeons should utilize this modality when appropriate to achieve optimal disease control and outcomes.
Core Tip: There are no definitive guidelines for managing metastatic neuroendocrine tumors (NETs) to the liver. Liver ablation is often used as an adjunct to surgical resection; however its effect on perioperative outcomes is unknown. In this retrospective National Surgical Quality Improvement Program study, patients undergoing liver ablation in conjunction with surgical resection were compared to patients undergoing hepatectomy alone. The aim of the study was to determine if ablation during hepatectomy increases the risk of adverse perioperative outcomes such as surgical site infections, bile leaks, and bleeding. We demonstrate that ablation is safe and does not increase the risk of adverse peroperative outcomes in patients undergoing hepatectomy for NET liver metastasis.
