Contemporary indications for and outcomes of hepatic resection for neuroendocrine liver metastases

Table 1 Demographic, clinical, and operative characteristics of patients with neuroendocrine liver metastases undergoing resection

	NELM (n = 669)
Median age in years, n (IQR)	60 (51-67)
Male gender, n (%)	341 (51)
ASA classification, n (%)
I	2 (0.3)
II	143 (21)
III	459 (69)
IV	61 (9)
Median BMI (kg/m2), n (IQR)	27.4 (24-32)
Comorbidities/preoperative
> 10% loss body weight in last 6 mo, n (%)	30 (4.4)
Diabetes mellitus with oral agents or insulin, n (%)	115 (17)
Current smoker within one yr, n (%)	79 (12)
Severe chronic obstructive pulmonary disease, n (%)	9 (0.3)
Congestive heart failure in 30 d before surgery, n (%)	5 (0.7)
Hypertension requiring medications, n (%)	326 (49)
Viral hepatitis, n (%)	13 (1.9)
Preoperative biliary stent, n (%)	13 (1.9)
Ascites within 30 d, n (%)	3 (0.4)
Preoperative sepsis, n (%)	2 (0.3)
Steroid use for a chronic condition, n (%)	20 (3)
Bleeding disorders, n (%)	18 (2.6)
Preoperative transfusion, n (%)	3 (0.4)
Neoadjuvant therapy, n (%)	119 (17.7)
Patients with concomitant procedure (%)	304 (45.4)
Total number of cholecystectomy	193 (28.8)
Total number of small/large bowel resection	135 (20.2)
Total number of partial pancreatectomy	23 (3.4)
Operative approach, n (%)
Open	546 (82)
Laparoscopic	113 (17)
Robotic	10 (1)
Liver resection type, n (%)
Trisegmentectomy	42 (6)
Right hepatectomy	99 (15)
Left hepatectomy	52 (8)
Partial lobectomy	476 (71)
Size of metastatic lesion, n (%)
< 2 cm	152 (23)
2-5 cm	303 (45)
> 5 cm	181 (27)
Unknown	33 (5)
Number of metastatic lesions, n (%)
< 2	298 (45)
3-5	168 (26)
> 5	166 (27)
Unknown	37 (2)
Concurrent partial liver resections, n (%)
0	205 (30.6)
1-5	385 (57.5)
6-9	44 (6.6)
> 10	5 (0.7)
Unknown	30 (4.5)
Liver texture, n (%)
Normal	190 (28)
Congested	8 (1)
Cirrhotic	12 (2)
Fatty	57 (9)
Unknown	402 (60)
Median optime in minutes, n (IQR)	232 (179-297)
Pringle maneuver during resection, n (%)	161 (24)
Biliary reconstruction, n (%)	14 (2)
Intraoperative ablation, n (%)	205 (30)
Drain placement	253 (38)

NELM: Neuroendocrine liver metastases; IQR: Interquartile range; BMI: Body mass index; ASA: American Society of Anesthesiology.

Table 2 Postoperative outcomes of patients with neuroendocrine liver metastases undergoing liver resection

	NELM (n = 669)
Post-hepatectomy
Bile leakage, n (%)	40 (5.9)
Post hepatectomy invasive intervention, n (%)	65 (9.7)
Post hepatectomy liver failure, n (%)	18 (2.6)
Specific complications
Superficial surgical site infection, n (%)	24 (3.5)
Deep incisional surgical site infection, n (%)	4 (0.6)
Organ/space surgical site infection, n (%)	49 (7.3)
Bleeding requiring transfusion, n (%)	104 (15.5)
Unplanned re-intubation, n (%)	9 (1.3)
Pneumonia, n (%)	20 (2.9)
Pulmonary embolism, n (%)	14 (2)
Progressive renal insufficiency, n (%)	7 (1.1)
Urinary tract infection, n (%)	14 (2)
Stroke, n (%)	1 (0.1)
Cardiac arrest, n (%)	2 (0.3)
Myocardial infarction, n (%)	3 (0.4)
Deep venous thrombosis/thrombophlebitis, n (%)	9 (1.4)
Sepsis, n (%)	38 (5.6)
Overall
Median length of hospital stay in days, n (IQR)	6 (4-8)
Discharge destination to home, n (%)	637 (95.2)
30-d readmission, n (%)	75 (11.2)
Reoperation, n (%)	21 (3.1)
30-d overall morbidity, n (%)	194 (29)
Mortality, n (%)	9 (1.3)

NELM: Neuroendocrine liver metastases; IQR: Interquartile range.

Table 3 Significant predictors of 30-d overall morbidity among patients undergoing hepatectomy for neuroendocrine liver metastases based on univariate logistic regression analysis

	OR	95%CI	P value
Age > 60	0.931	0.658-1.316	0.6835
Male gender	1.232	0.890-1.707	0.2092
ASA class ≥ 3	2.418	1.422-4.113	0.0011
BMI > 27	1.030	0.743-1.428	0.8596
Preop biliary stent	2.562	0.850-7.719	0.0946
Viral hepatitis	2.538	0.841-7.660	0.0983
Concomitant bowel resection	1.278	0.885-1.844	0.1906
Concomitant cholecystectomy	1.094	0.749-1.598	0.6431
Concomitant pancreatectomy	1.579	0.626-3.984	0.3335
Open approach	1.943	1.218-3.102	0.0053
Size < 2 cm (ref)
Size 2-5 cm	0.989	0.645-1.516	0.9591
Size > 5 cm	1.397	0.882-2.215	0.1546
Number of tumors > 1	0.984	0.681-1.422	0.9317
Right/left/triseg hepatectomy	1.660	1.169-2.355	0.0046
Abnormal liver texture	1.340	0.818-2.193	0.2447
Intraoperative ablation	0.686	0.476-0.988	0.0431
Biliary reconstruction	3.979	1.317-12.023	0.0144
Operative time > 230 min	2.043	1.407-2.968	0.0002
Pringle	1.429	0.986-2.070	0.0593

OR: Odds ratio; CI: Confidence intervals; ASA: American Society of Anesthesiologists; BMI: Body mass index.

Table 4 Significant predictors of 30-d overall morbidity among patients undergoing hepatectomy for neuroendocrine liver metastases based on multivariate stepwise logistic regression analysis

	OR	95%CI	P value
ASA class ≥ 3	2.089	1.197-3.645	0.0095
Normal liver texture	0.641	0.433-0.950	0.0266
Open approach	1.867	1.148-3.036	0.0118
Right hepatectomy	1.618	1.014-2.582	0.0437
Intraoperative ablation	0.697	0.473-1.029	0.0697
Biliary reconstruction	2.802	0.870-9.021	0.0842
Operative time > 230 min	1.731	1.168-2.565	0.0062

OR: Odds ratio; CI: Confidence intervals; ASA: American Society of Anesthesiologists.