Contemporary indications for and outcomes of hepatic resection for neuroendocrine liver metastases  

作　　者：Steven D Scoville Dimitrios Xourafas Aslam M Ejaz Allan Tsung Timothy Pawlik Jordan M Cloyd 

机构地区：[1]Department of Surgery,Division of Surgical Oncology at The Ohio State University,James Cancer Center,Columbus,OH 43210,United States [2]The Arthur G James Comprehensive Cancer Center and Solove Research Institute,The Ohio State University,Columbus,OH 43210,United States [3]Department of Surgery,Harvard Medical School,Department of Surgery,Brigham and Women's Hospital,Harvard Medical School,Boston,MA 02215,United States [4]Department of Surgery,The Ohio State University,Columbus,OH 43210,United States [5]Department of Surgery,The Ohio State University Wexner Medical Center,Columbus,OH 43210,United States [6]Department of Surgery,Division of Surgical Oncology,The Ohio State University Wexner Medical Center,Columbus,OH 43210,United States

出　　处：《World Journal of Gastrointestinal Surgery》2020年第4期159-170,共12页世界胃肠外科杂志（英文版）（电子版）

摘　　要：BACKGROUND Although surgical resection is associated with the best long-term outcomes for neuroendocrine liver metastases(NELM),the current indications for and outcomes of surgery for NELM from a population perspective are not well understood.AIM To determine the current indications for and outcomes of liver resection(LR)for NELM using a population-based cohort.METHODS A retrospective review of the 2014-2017 American College of Surgeons National Surgical Quality Improvement Program and targeted hepatectomy databases was performed to identify patients who underwent LR for NELM.Perioperative characteristics and 30-d morbidity and mortality were analyzed.RESULTS Among 669 patients who underwent LR for NELM,the median age was 60(interquartile range:51-67)and 51%were male.While the number of metastases resected ranged from 1 to 9,the most common(45%)number of tumors resected was one.The majority(68%)of patients had a largest tumor size of<5 cm.Most patients underwent partial hepatectomy(71%)while fewer underwent a right or left hepatectomy or trisectionectomy.The majority of operations were open(82%)versus laparoscopic(17%)or robotic(1%).In addition,30%of patients underwent intraoperative ablation while 45%had another concomitant operation including cholecystectomy(28.8%),bowel resection(20.2%),or partial pancreatectomy(3.4%).Overall 30-d morbidity and mortality was 29%and 1.3%,respectively.On multivariate analysis,American Society of Anesthesiologists class≥3[odds ratios(OR),OR=2.089,95%confidence intervals(CI):1.197-3.645],open approach(OR=1.867,95%CI:1.148-3.036),right hepatectomy(OR=1.618,95%CI:1.014-2.582),and prolonged operative time of>230 min(OR=1.731,95%CI:1.168-2.565)were associated with higher 30-d morbidity while intraoperative ablation and concomitant procedures were not.CONCLUSION LR for NELM was performed with relatively low postoperative morbidity and mortality.Concomitant procedures performed at the time of LR did not increase morbidity.

关 键 词：CARCINOID NEUROENDOCRINE TUMOR Primary TUMOR RESECTION INTRAOPERATIVE ablation CHOLECYSTECTOMY Small bowel RESECTION 

分 类 号：R735.7[医药卫生—肿瘤]