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LIVER RESECTION FOR NEUROENDOCRINE TUMORS LIVER METASTASES IN TRANSPLANTABLE PATIENTS WITHIN THE MILAN CRITERIA
Andrea Ruzzenente*1, Francesca Bertuzzo1, Fabio Bagante1, Luca Aldrighetti2, Giorgio Ercolani3, Felice Giuliante4, Alessandro Ferrero5, Gian Luca Grazi6, Andrea Ciangherotti1, Alfredo Guglielmi1, Calogero Iacono1
1Department of Surgery , University of Verona Medical School, Verona, Italy; 2Department of surgery, Humanitas Hospital, Rozzano, Italy; 3Department of surgery, Ospedale Sant'Orsola Malpighi, Bologna, Italy; 4Department of surgery, policlinico Gemelli, Roma, Italy; 5Department of surgery, Ospedale Mauriziano, Torino, Italy; 6Department of Surgery, Regina Elena National Tumor Institute, Roma, Italy
Background Liver transplantation (LT) has been prosed as a curative treatment for metastatic gastro-entero-pancreatic neuroendocrine tumors (GEP-NETs) but there is a lack of consensus on its real benefit when compared with hepatectomy. We sought to analyze survival outcomes of patients undergoing liver resection for GEP-NETs liver metastasis (NELM) according to the Milan Criteria proposed to select patients with GEP-NET candidate to LT.
Methods: A multicentric national database including seven tertiary referral Hepato-biliary-pancreatic centers was used to identify patients who underwent hepatectomy for NELM between January 1990 and December 2014. We identify patients fulfilling Milan Criteria: well-differentiated NET (Ki-67<10%), age <60 years, no extrahepatic disease, primary NET resected, stable disease for >6 months, and <50% liver involvement (Group 1). Extended Milan Criteria included patients up to 70 years age old (Group 2). Recurrence after liver surgery was treated per standard protocols according to international guidelines. No patients underwent liver transplantation during the follow-up
Results: A total of 238 patients were included in our study. Among them, 23 (10%) patients were in Group 1 while 35 (15%) in Group 2. In Group 1 and Group 2, 12 (52%) and 20 (57%) patients had a pancreatic NET, respectively. Median Ki-67 was 5% (IQR,1-7) in both Group 1 and Group 2. In Group 1, 4 (17%) and 17 (74%) patients had NELM of type I and II according to Frilling classification compared with 8 (23%) and 22 (63%) patients in Group 2. While 5-year OS for the whole cohort was 67%, 5-year OS for Group 1 and Group 2 was 80% and 77%, respectively.
Conclusions: In our series, only 10% of patients fulfilled Milan criteria. The 5-year OS after hepatectomy of this small selected group was comparable with that reported in the literature for patients undergoing LT for NELM within Milan criteria.
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