Surgery Provides Long-Term Survival in Patients with Metastatic Neuroendocrine Tumors Undergoing Resection for Non-Hormonal Symptoms

Jeffery Chakedis, Eliza W. Beal, Alexandra G. Lopez-Aguiar, George Poultsides, Eleftherios Makris, Flavio G. Rocha, Zaheer Kanji, Sharon Weber, Alexander Fisher, Ryan Fields, Bradley A. Krasnick, Kamran Idrees, Paula Marincola-Smith, Clifford Cho, Megan Beems, Timothy M. Pawlik, Shishir K. Maithel, Carl R. Schmidt, Mary Dillhoff

Research output: Contribution to journalArticle

6 Scopus citations

Abstract

Introduction: Patients with metastatic neuroendocrine tumor (NET) often have an indolent disease course yet the outcomes for patients with metastatic NET undergoing surgery for non-hormonal (NH) symptoms of GI obstruction, bleeding, or pain is not known. Methods: We identified patients with metastatic gastroenteropancreatic NET who underwent resection from 2000 to 2016 at 8 academic institutions who participated in the US Neuroendocrine Tumor Study Group. Results: Of 581 patients with metastatic NET to liver (61.3%), lymph nodes (24.1%), lung (2.1%), and bone (2.5%), 332 (57.1%) presented with NH symptoms of pain (n = 223, 67.4%), GI bleeding (n = 54, 16.3%), GI obstruction (n = 49, 14.8%), and biliary obstruction (n = 22, 6.7%). Most patients were undergoing their first operation (85.4%) within 4 weeks of diagnosis. The median overall survival was 110.4 months, and operative intent predicted survival (p < 0.001) with 66.3% undergoing curative resection. Removal of all metastatic disease was associated with the longest median survival (112.5 months) compared to debulking (89.2 months), or palliative resection (50.0 months; p < 0.001). The 1-, 3-, and 12-month mortality was 3.0%, 4.5%, and 9.0%, respectively. Factors associated with 1-year mortality included palliative operations (OR 6.54, p = 0.006), foregut NET (5.62, p = 0.042), major complication (4.91, p = 0.001), and high tumor grade (11.2, p < 0.001). The conditional survival for patients who lived past 1 year was 119 months. Conclusions: Patients with metastatic NET and NH symptoms that necessitate surgery have long-term survival, and goals of care should focus on both oncologic and quality of life impact. Surgical intervention remains a critical component of multidisciplinary care of symptomatic patients.

Original languageEnglish
Pages (from-to)122-134
Number of pages13
JournalJournal of Gastrointestinal Surgery
Volume23
Issue number1
DOIs
StatePublished - Jan 15 2019

Keywords

  • Metastatic
  • Neuroendocrine tumor
  • Non-hormonal
  • Palliative surgery
  • Symptoms

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    Chakedis, J., Beal, E. W., Lopez-Aguiar, A. G., Poultsides, G., Makris, E., Rocha, F. G., Kanji, Z., Weber, S., Fisher, A., Fields, R., Krasnick, B. A., Idrees, K., Marincola-Smith, P., Cho, C., Beems, M., Pawlik, T. M., Maithel, S. K., Schmidt, C. R., & Dillhoff, M. (2019). Surgery Provides Long-Term Survival in Patients with Metastatic Neuroendocrine Tumors Undergoing Resection for Non-Hormonal Symptoms. Journal of Gastrointestinal Surgery, 23(1), 122-134. https://doi.org/10.1007/s11605-018-3986-4