Skip to main content
 
Notice: Users may be experiencing issues with displaying some pages on stanfordhealthcare.org. We are working closely with our technical teams to resolve the issue as quickly as possible. Thank you for your patience.
Stanford Health Care

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

Surgery Provides Long-Term Survival in Patients with Metastatic Neuroendocrine Tumors Undergoing Resection for Non-Hormonal Symptoms. Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract 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. 2018

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 4weeks of diagnosis. The median overall survival was 110.4months, 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 (112.5months) compared to debulking (89.2months), or palliative resection (50.0months; 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 1year was 119months.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.

View details for PubMedID 30334178