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THE IMPACT OF EXTENT OF LIVER RESECTION AMONG PATIENTS WITH NEUROENDOCRINE LIVER METASTASIS: AN INTERNATIONAL MULTI-INSTITITUIONAL STUDY
Aslam Ejaz*1, Fabio Bagante2, Brad N. Reames1, Shishir K. Maithel3, George A. Poultsides4, Todd W. Bauer5, Ryan Fields6, Matthew J. Weiss1, Hugo P. Marques7, Luca Aldrighetti8, Timothy M. Pawlik2, Jin He1
1Johns Hopkins University, Baltimore, MD; 2The Ohio State University, Columbus, OH; 3Emory University, Atlanta, GA; 4Stanford University, Stanford, CA; 5University of Virginia, Charlottesville, VA; 6Washington University, St. Louis, MO; 7Curry Cabral Hospital, Lisbon, Portugal; 8Scientific Institute San Raffaele, Milan, Italy
Introduction: Liver resection in patients with neuroendocrine liver metastasis (NELM) provides a survival benefit, yet the optimal extent of resection remains unknown. We sought to examine outcomes of patients undergoing non-anatomical (wedge) versus anatomical liver resection for NELM using a large international cohort of patients.
Methods: 258 patients who underwent curative-intent liver resection were identified from 8 institutions. Patients were excluded if they underwent concurrent ablation, had extrahepatic disease, underwent a debulking operation, or had mixed anatomical and non-anatomical resections. Overall (OS) and disease-free (DFS) survival were compared among patients based on the extent of liver resection (wedge vs. anatomical).
Results: Most primary tumors were located in the pancreas (n=117, 45.4%) or the small intestine (n=65, 25.2%). Liver resection consisted of wedge (n=126, 48.8%) or anatomical (n=132, 51.2%) resection. The overwhelming majority of patients who underwent a wedge resection had an estimated liver involvement of <50% (wedge: 109, 97.3% vs. anatomical: n=82, 65.6%; P<0.001). Patients who underwent a wedge resection also had higher rates of primary tumor lymph node metastasis (wedge: n=79, 71.2% vs. anatomical: 37, 33.6%; P<0.001) and microscopically positive margins (R1) (wedge: n=29, 25.7% vs. anatomical: n=16, 12.5%; P=0.009). After a median follow-up of 47.7 months, 48 (18.6%) patients died and 37.0% (n=95) had evidence of disease recurrence. Patients who underwent an anatomical resection had both longer median OS (Not reached) and DFS (Not reached) versus patients who underwent a wedge resection (median OS: 138.3 months; median DFS: 31.3 months) (both P<0.01). After controlling for patient and disease-related factors, extent of liver resection was independently with an increased risk of recurrence (HR: 2.39, 95%CI 1.04-5.48; P=0.04) but not death (HR1.92, 95%CI 0.40-9.28; P=0.42).
Conclusion: Non-anatomical liver wedge resections are independently associated with a higher incidence of recurrence versus patients who undergo a formal hepatectomy.
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