Department of Surgery, The Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Halsted 614, Baltimore, MD, 21287, USA.
Division of Surgical Oncology, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA.
J Gastrointest Surg. 2019 Mar;23(3):484-491. doi: 10.1007/s11605-018-3862-2. Epub 2018 Jul 6.
Liver resection in patients with neuroendocrine liver metastasis (NELM) provides a survival benefit, yet the optimal extent of resection remains unknown. We sought to examine outcomes of patients undergoing non-anatomic (NAR) versus anatomic liver resection (AR) for NELM using a large international cohort of patients.
Two hundred and fifty-eight patients who underwent curative intent liver resection from January 1990 to December 2016 were identified from eight institutions. Patients were excluded if they underwent concurrent ablation, had extrahepatic disease, underwent a debulking operation, or had mixed anatomic and non-anatomic resections. Overall (OS) and recurrence-free (RFS) survival were compared among patients based on the extent of liver resection (AR vs. NAR).
Most primary tumors were located in the pancreas (n = 117, 45.4%) or the small intestine (n = 65, 25.2%). Liver resection consisted of NAR (n = 126, 48.8%) or AR (n = 132, 51.2%) resection. The overwhelming majority of patients who underwent NAR had an estimated liver involvement of < 50% (NAR 109, 97.3% vs. AR n = 82, 65.6%; P < 0.001). Patients who underwent NAR also had higher rates of primary tumor lymph node metastasis (NAR n = 79, 71.2% vs. AR n = 37, 33.6%; P < 0.001) and microscopically positive margins (R1) (NAR n = 29, 25.7% vs. AR n = 16, 12.5%; P = 0.009). After a median follow-up of 47.7 months, 48 (18.6%) patients died and 37.0% (n = 95) had evidence of disease recurrence. Patients who underwent AR had both longer median OS (not reached) and RFS (not reached) versus patients who underwent NAR (median OS 138.3 months; median RFS 31.3 months) (both P < 0.01). After controlling for patient and disease-related factors, extent of liver resection was independently associated with an increased risk of recurrence (HR 2.39, 95% CI 1.04-5.48; P = 0.04) but not death (HR 1.92, 95% CI 0.40-9.28; P = 0.42).
NAR was independently associated with a higher incidence of recurrence versus patients who undergo a formal anatomic hepatectomy among patients with NELM.
对于神经内分泌肝脏转移瘤（NELM）患者，肝切除术可带来生存获益，但最佳切除范围仍不明确。我们旨在利用大型国际患者队列，研究非解剖性肝切除术（NAR）与解剖性肝切除术（AR）治疗 NELM 的疗效。
从 1990 年 1 月至 2016 年 12 月，8 家机构共确定了 258 例接受根治性肝切除术的患者。如果患者同时接受消融治疗、有肝外疾病、接受减瘤手术或进行混合解剖性和非解剖性肝切除术，则排除在外。基于肝切除术的范围（AR 与 NAR），比较患者的总生存（OS）和无复发生存（RFS）。
大多数原发性肿瘤位于胰腺（n=117，45.4%）或小肠（n=65，25.2%）。肝切除术包括 NAR（n=126，48.8%）或 AR（n=132，51.2%）。绝大多数接受 NAR 的患者估计肝受累程度＜50%（NAR 109 例，97.3%比 AR n=82，65.6%；P＜0.001）。接受 NAR 的患者也具有更高的原发性肿瘤淋巴结转移率（NAR n=79，71.2%比 AR n=37，33.6%；P＜0.001）和显微镜下阳性切缘（R1）（NAR n=29，25.7%比 AR n=16，12.5%；P=0.009）。中位随访 47.7 个月后，48 例（18.6%）患者死亡，37.0%（n=95）有疾病复发的证据。与接受 NAR 的患者相比，接受 AR 的患者的中位 OS（未达到）和 RFS（未达到）均更长（中位 OS：未达到；中位 RFS：31.3 个月）（均 P＜0.01）。在校正患者和疾病相关因素后，肝切除术的范围与复发风险增加独立相关（HR 2.39，95%CI 1.04-5.48；P=0.04），但与死亡无关（HR 1.92，95%CI 0.40-9.28；P=0.42）。
在 NELM 患者中，与接受正式解剖性肝切除术的患者相比，NAR 与更高的复发发生率独立相关。
