Surgical resection of hepatic metastases from neuroendocrine neoplasms: A systematic review

Abstract: Background: Neuroendocrine tumours (NET) most commonly metastasize to the liver. Hepatic resection of NET hepatic metastases (NETHM) has been shown to improve symptomology and survival. Methods: A systematic review of clinical studies before September 2010 was performed to examine the efficacy of hepatic resection for NETHM. As a secondary end-point, the impact of treatment on safety and symptomology were determined and prognostic variables were identified. The quality of each study was also assessed using predefined criteria incorporating 9 characteristics. Clinical outcome was synthesized through a narrative review with full tabulation of results of all included studies. Results: Twenty-nine included reported survival outcomes with a median 3-, 5- and 10-year overall survival of 83% (range, 63–100%), 70.5% (range, 31–100%), and 42% (range, 0–100%), respectively. The median progression-free survival (PFS) was 21 months (range, 13–46 months) and median 1-,3-,5- and 10-year PFS of 63% (range, 50–80 %), 32% (range, 24–69%), 29% (range, 6–66%) and 1% (range, 0–11%), respectively. Poor histologic grade, extra-hepatic disease and a macroscopically incomplete resection were associated with a poor prognosis. Studies reported a median rate of symptomatic relief from surgery in 95% of patients (range, 50–100%). Conclusion: Hepatic resection for NETHM provides symptomatic benefit and is associated with favourable survival outcomes although the majority of patients invariably develop disease progression. [Copyright &y& Elsevier]