Surgical treatment of neuroendocrine XXXX to the liver: a plea for resection to increase survival.

@entity1 @entity4294 @entity5 @entity299 @entity2744 @entity4303 @entity3 @entity1130
BACKGROUND: Hepatic @entity3 from @entity5 have a protracted natural history and are associated with @entity2744 . Resection is indicated for symptom control. Previous reports have suggested improvement in survival for @entity1 undergoing debulking procedures. STUDY DESIGN: The records of all consecutive @entity1 undergoing resection of hepatic @entity3 from @entity5 between 1977 and 1998 were reviewed. @entity5 were classified according to histology, endocrine activity, and primary location. @entity1 lost to followup before 1 year were excluded. Followups were based on outpatient evaluations and were updated by correspondence. The Kaplan-Meier method was used to generate survival and recurrence curves, and the log-rank test was used for comparison. RESULTS: A total of 170 @entity1 fulfilled the inclusion criteria, of whom 73 were @entity1 . Mean age (+/-SD) was 57 (+/-11.5) years. @entity4303 (n = 120) and nonfunctioning @entity4294 (n = 18) predominated; the ileum (n = 85) and the pancreas (n = 52) were the most common primary sites. Major hepatectomy (one or more lobes) was performed in 91 @entity1 (54%). The postoperative complication rate was 14%, and two @entity1 died (1.2%). Operation controlled symptoms in 104 of 108 @entity1 , but the recurrence rate at 5 years was 59%. Operation decreased @entity1130 levels considerably, and no @entity1 experienced @entity299 postoperatively. Recurrence rate was 84% at 5 years. Overall survival was 61% and 35% at 5 and 10 years, respectively, with no difference between @entity4303 and @entity4294 . CONCLUSIONS: Hepatic resection for metastatic @entity5 is safe and achieves symptom control in most @entity1 . Debulking extends survival, although recurrence is expected. Hepatic resection is justified by its effects on survival and quality of life.
