• Skye C Mayo, Mechteld C de Jong, Mark Bloomston, Carlo Pulitano, Bryan M Clary, Srinevas K Reddy, Clark Gamblin T T, Scott A Celinski, David A Kooby, Charles A Staley, Jayme B Stokes, Carrie K Chu, David Arrese, Alessandro Ferrero, Richard D Schulick, Michael A Choti, Jean-Francois H Geschwind, Jennifer Strub, Todd W Bauer, Reid B Adams, Luca Aldrighetti, Gilles Mentha, Lorenzo Capussotti, and Timothy M Pawlik.
• Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
• Ann. Surg. Oncol. 2011 Dec 1; 18 (13): 3657-65.

BackgroundManagement of patients with neuroendocrine liver metastasis (NELM) remains controversial. We sought to examine the relative efficacy of surgical management versus intra-arterial therapy (IAT) for NELM and determine factors predictive of survival.MethodsA total of 753 patients who had surgery (n = 339) or IAT (n = 414) for NELM from 1985 to 2010 were identified from nine hepatobiliary centers. Clinicopathologic data were assessed with regression modeling and propensity score matching.ResultsMost patients had a pancreatic (32%) or a small bowel (27%) primary tumor; 47% had a hormonally active tumor. There were statistically significant differences in characteristics between surgery versus IAT groups (hormonally active tumors: 28 vs. 48%; hepatic tumor burden >25%: 52% vs. 76%) (all P < 0.001). Among surgical patients, most underwent hepatic resection alone without ablation (78%). The median number of IAT treatments was 1 (range, 1-4). Median and 5-year survival of patients treated with surgery was 123 months and 74% vs. 34 months and 30% for IAT (P < 0.001). In the propensity-adjusted multivariate Cox model, asymptomatic disease (hazard ratio 2.6) was strongly associated with worse outcome (P = 0.001). Although surgical management provided a survival benefit over IAT among symptomatic patients with >25% hepatic tumor involvement, there was no difference in long-term outcome after surgery versus IAT among asymptomatic patients (P = 0.78).ConclusionsAsymptomatic patients with a large (>25%) burden of liver disease benefited least from surgical management and IAT may be a more appropriate treatment strategy. Surgical management of NELM should be reserved for patients with low-volume disease or for those patients with symptomatic high-volume disease.

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