Outcome of liver resection for small bowel neuroendocrine tumour metastases
<p><strong>Background</strong> Small bowel neuroendocrine tumours frequently metastasise to the liver. While liver resection improves survival and provides symptomatic relief, multifocal bilobar disease adds complexity to surgical management.</p> <p><strong>Object...
| Main Authors: | , , , , |
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| Format: | Journal article |
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Academy of Science of South Africa
2018
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| _version_ | 1826266276799971328 |
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| author | Polkinghorne, MD Krige, JEJ Jonas, E Kotze, UK Bernon, MM |
| author_facet | Polkinghorne, MD Krige, JEJ Jonas, E Kotze, UK Bernon, MM |
| author_sort | Polkinghorne, MD |
| collection | OXFORD |
| description | <p><strong>Background</strong> Small bowel neuroendocrine tumours frequently metastasise to the liver. While liver resection improves survival and provides symptomatic relief, multifocal bilobar disease adds complexity to surgical management.</p> <p><strong>Objectives</strong> This study evaluated outcome in patients with small bowel neuroendocrine liver metastases who underwent liver resection at Groote Schuur Hospital and UCT Private Academic Hospital.</p> <p><strong>Methods</strong> All patients with small bowel neuroendocrine liver metastases treated with resection from 1990-2015 were identified from a prospective departmental database. Demographic data, operative management, morbidity and mortality using the Accordion classification were analysed. Survival was assessed using the Kaplan-Meier method.</p> <p><strong>Results</strong> Seventeen patients (9 women, 8 men, median age 55 years, range 31-76) underwent resection. Each patient had all identifiable liver metastases resected and/or ablated (median n = 3, range 1-20). Ten patients had major anatomical liver resections. Three patients had five segments resected, and seven had four resected. Nine patients (53%) had a concurrent bowel resection of the small bowel NET primary and a regional mesenteric lymphadenectomy. Median operating time was 255 min (range 150-720). Median blood-loss was 800 ml (range 200-10,000). Five patients required intraoperative blood transfusion. Hepatic vascular inflow control was used in ten patients (56.5 min median, range 20-150 min), which included hepatic inflow control n = 8, total hepatic exclusion n = 1, and selective hepatic exclusion n = 1. Median postoperative hospital stay was 9 days (range 2-28). Thirteen complications occurred in seven patients. Accordion grades were 1 n = 3, 2 n = 4, 3 n = 3, 4 n = 2, 6 n = 1. One patient required reoperation for bleeding and a bile leak. One patient died of a myocardial infarction 36 hours postoperatively. Sixteen patients (94%) had symptomatic improvement. Five-year overall survival was 91% (median follow-up 36 months, range 14-86 months.</p> <p><strong>Conclusion</strong> Our data show that liver resection can be safely performed for small bowel NET metastases with a good 5-year survival. However, a substantial number of patients require a major liver resection and these patients are best managed at a multidisciplinary referral centre</p> |
| first_indexed | 2024-03-06T20:36:27Z |
| format | Journal article |
| id | oxford-uuid:32cc51d1-82bd-4f8f-b4e4-ec4cf361d8eb |
| institution | University of Oxford |
| last_indexed | 2024-03-06T20:36:27Z |
| publishDate | 2018 |
| publisher | Academy of Science of South Africa |
| record_format | dspace |
| spelling | oxford-uuid:32cc51d1-82bd-4f8f-b4e4-ec4cf361d8eb2022-03-26T13:16:20ZOutcome of liver resection for small bowel neuroendocrine tumour metastasesJournal articlehttp://purl.org/coar/resource_type/c_dcae04bcuuid:32cc51d1-82bd-4f8f-b4e4-ec4cf361d8ebSymplectic Elements at OxfordAcademy of Science of South Africa2018Polkinghorne, MDKrige, JEJJonas, EKotze, UKBernon, MM<p><strong>Background</strong> Small bowel neuroendocrine tumours frequently metastasise to the liver. While liver resection improves survival and provides symptomatic relief, multifocal bilobar disease adds complexity to surgical management.</p> <p><strong>Objectives</strong> This study evaluated outcome in patients with small bowel neuroendocrine liver metastases who underwent liver resection at Groote Schuur Hospital and UCT Private Academic Hospital.</p> <p><strong>Methods</strong> All patients with small bowel neuroendocrine liver metastases treated with resection from 1990-2015 were identified from a prospective departmental database. Demographic data, operative management, morbidity and mortality using the Accordion classification were analysed. Survival was assessed using the Kaplan-Meier method.</p> <p><strong>Results</strong> Seventeen patients (9 women, 8 men, median age 55 years, range 31-76) underwent resection. Each patient had all identifiable liver metastases resected and/or ablated (median n = 3, range 1-20). Ten patients had major anatomical liver resections. Three patients had five segments resected, and seven had four resected. Nine patients (53%) had a concurrent bowel resection of the small bowel NET primary and a regional mesenteric lymphadenectomy. Median operating time was 255 min (range 150-720). Median blood-loss was 800 ml (range 200-10,000). Five patients required intraoperative blood transfusion. Hepatic vascular inflow control was used in ten patients (56.5 min median, range 20-150 min), which included hepatic inflow control n = 8, total hepatic exclusion n = 1, and selective hepatic exclusion n = 1. Median postoperative hospital stay was 9 days (range 2-28). Thirteen complications occurred in seven patients. Accordion grades were 1 n = 3, 2 n = 4, 3 n = 3, 4 n = 2, 6 n = 1. One patient required reoperation for bleeding and a bile leak. One patient died of a myocardial infarction 36 hours postoperatively. Sixteen patients (94%) had symptomatic improvement. Five-year overall survival was 91% (median follow-up 36 months, range 14-86 months.</p> <p><strong>Conclusion</strong> Our data show that liver resection can be safely performed for small bowel NET metastases with a good 5-year survival. However, a substantial number of patients require a major liver resection and these patients are best managed at a multidisciplinary referral centre</p> |
| spellingShingle | Polkinghorne, MD Krige, JEJ Jonas, E Kotze, UK Bernon, MM Outcome of liver resection for small bowel neuroendocrine tumour metastases |
| title | Outcome of liver resection for small bowel neuroendocrine tumour metastases |
| title_full | Outcome of liver resection for small bowel neuroendocrine tumour metastases |
| title_fullStr | Outcome of liver resection for small bowel neuroendocrine tumour metastases |
| title_full_unstemmed | Outcome of liver resection for small bowel neuroendocrine tumour metastases |
| title_short | Outcome of liver resection for small bowel neuroendocrine tumour metastases |
| title_sort | outcome of liver resection for small bowel neuroendocrine tumour metastases |
| work_keys_str_mv | AT polkinghornemd outcomeofliverresectionforsmallbowelneuroendocrinetumourmetastases AT krigejej outcomeofliverresectionforsmallbowelneuroendocrinetumourmetastases AT jonase outcomeofliverresectionforsmallbowelneuroendocrinetumourmetastases AT kotzeuk outcomeofliverresectionforsmallbowelneuroendocrinetumourmetastases AT bernonmm outcomeofliverresectionforsmallbowelneuroendocrinetumourmetastases |