The impact of extrahepatic disease among patients undergoing liver-directed therapy for neuroendocrine liver metastasis

IntroductionManagement of neuroendocrine liver metastasis (NELM) in the presence of extrahepatic disease (EHD) is controversial. We sought to examine outcomes of patients undergoing liver-directed therapy (resection, ablation, or both) for NELM in the presence of EHD using a large international cohort of patients. Methods612 patients who underwent liver-directed therapy were identified from eight institutions. Postoperative outcomes, as well as and overall (OS) were compared among patients with and without EHD. ResultsMost primary tumors were located in the pancreas (N=254;41.8%) or the small bowel (N=188;30.9%). Patients underwent surgery alone (N=471;77.0%), ablation alone (N=15;2.5%), or a combined approach (N=126;20.6%). Patients with EHD had more high-grade tumors (EHD: 44.4% vs no EHD: 16.1%; P<0.001). EHD was often the peritoneum (N=29;41.4%) or lung (N=19;27.1%). Among 70 patients with EHD, 20.0% (N=14) underwent concurrent resection for EHD. After median follow-up of 51 months, 174 (28.4%) patients died with a median OS of 140.4 months. Patients with EHD had a shorter median OS versus patients who did not have EHD (EHD: 87 months vs no EHD: not reached; P=0.002). EHD was independently associated with an increased risk of death (HR: 2.56, 95%CI 1.16-5.62; P=0.02). ConclusionPatients with NELM and EHD had more aggressive tumors, conferring a twofold increased risk of death. Surgical treatment of NELM among patients with EHD should be individualized.