Liver resection for liver metastases from nondigestive endocrine cancer

Abstract

Background

For patients with hepatic nondigestive endocrine metastases (HNEM), the role of liver resection is not well-defined.

Methods

We reviewed outcomes for patients who underwent liver resection for HNEM at 2 centers to identify predictors of survival.

Results

From 1991 to 2010, 51 patients underwent liver resection for HNEM. Primary tumor types were adrenal gland (n = 26), thyroid (n = 11), testicular germ cell (n = 9), and ovarian granulosa cell (n = 5). 28 patients (55%) had synchronous or early (diagnosed within 12 months after primary tumor resection) liver metastases. At liver resection, 26 patients (51%) had extrahepatic metastases, and 7 (14%) had ≥2 sites of extrahepatic metastases. 32 patients (63%) had major liver resection and 19 (37%) had a simultaneous extrahepatic procedure. 90-day postoperative morbidity and mortality rates were 27% and 2%, respectively. After median follow-up of 20 months (range, 1–144), the 5-year overall and recurrence-free survival rates were 58% and 37%, respectively. Survival was not affected by primary tumor type. In multivariate analysis, ≥2 sites of extrahepatic metastases (hazard ratio [HR] = 4.80; 95% confidence interval [CI] = 1.18–19.50; P = .028) and interval of ≤12 months between primary tumor resection and diagnosis of liver metastases (HR = 5.33; 95% CI = 1.11–25.71; P = .037) were associated with worse overall survival after liver resection.

Conclusion

For selected patients, liver resection for HNEM is associated with long-term survival. The number of extrahepatic sites of metastasis and the timing of appearance of liver metastases should be considered in patient selection.

Liver resection is currently the treatment of choice for patients with liver metastases from colorectal cancer; 5-year survival rates as high as 58% have been reported with this approach and establish surgery as a curative option in patients with this form of advanced malignant colorectal disease.1 and 2 Patients with liver metastases from neuroendocrine cancer also benefit from liver resection with 5-year survival rates of up to 74% and reduction of disease-specific symptoms justifying liver resection in this patient cohort.3, 4, 5 and 6

In contrast, the benefit of liver resection for patients with liver metastases from nondigestive endocrine cancer (hepatic nondigestive endocrine metastases [HNEM]) is controversial as most of these patients present with coexistent extrahepatic metastases.7, 8 and 9 Previously published data on outcomes after resection of HNEM suggest that surgery may improve survival in selected patients. However, these reports included various types of malignancies and relatively small sample sizes, which limits the ability to draw strong conclusions regarding patient selection.9, 10, 11 and 12 Given improvements in the efficacy of systemic therapy for endocrine tumors13 and 14 and improvements in the safety of liver resection,15 the number of patients with HNEM who are potential candidates for surgery is increasing.

In this study, we evaluated the postoperative and long-term outcomes of patients who underwent liver resection for HNEM. In addition, we analyzed pretreatment factors associated with outcome to identify a cohort of patients with HNEM who most benefit from operative intervention.