Annals of Hepato-Biliary-Pancreatic Surgery (한국간담췌외과학회지)

The Korean Association of Hepato-Biliary-Pancreatic Surgery (한국간담췌외과학회)
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Impact of the extent of resection of neuroendocrine tumor liver metastases on survival: A systematic review and meta-analysis

  • Rugved Kulkarni (Department of HPB and Liver Transplantation, Queen Elizabeth Hospital) ;
  • Irfan Kabir (Department of HPB and Liver Transplantation, Queen Elizabeth Hospital) ;
  • James Hodson (Institute of Translational Medicine, Queen Elizabeth Hospital) ;
  • Syed Raza (Department of HPB and Liver Transplantation, Queen Elizabeth Hospital) ;
  • Tahir Shah (Department of Neuroendocrine Medicine and Hepatology, Queen Elizabeth Hospital) ;
  • Sanjay Pandanaboyana (HPB and Liver Transplant Unit, Newcastle University) ;
  • Bobby V. M. Dasari (Department of HPB and Liver Transplantation, Queen Elizabeth Hospital)
  • Received : 2021.07.05
  • Accepted : 2021.09.14
  • Published : 2022.02.28
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Abstract

In patients with neuroendocrine tumors with liver metastases (NETLMs), complete resection of both the primary and liver metastases is a potentially curative option. When complete resection is not possible, debulking of the tumour burden has been proposed to prolong survival. The objective of this systematic review was to evaluate the effect of curative surgery (R0-R1) and debulking surgery (R2) on overall survival (OS) in NETLMs. For the subgroup of R2 resections, outcomes were compared by the degree of hepatic debulking (≥ 90% or ≥ 70%). A systematic review of the literature was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines using PubMed, Medline, CINAHL, Cochrane, and Embase databases. Hazard ratios (HRs) were estimated for each study and pooled using a random-effects inverse-variance meta-analysis model. Of 538 articles retrieved, 11 studies (1,729 patients) reported comparisons between curative and debulking surgeries. After pooling these studies, OS was found to be significantly shorter in debulking resections, with an HR of 3.49 (95% confidence interval, 2.70-4.51; p < 0.001). Five studies (654 patients) compared outcomes between ≥ 90% and ≥ 70% hepatic debulking approaches. Whilst these studies reported a tendency for OS and progression-free survival to be shorter in those with a lower degree of debulking, they did not report sufficient data for this to be assessed in a formal meta-analysis. In patients with NETLM, OS following surgical resection is the best to achieve R0-R1 resection. There is also evidence for a progressive reduction in survival benefit with lesser debulking of tumour load.

Keywords

Acknowledgement

Dr Rebecca Glover, for her initial help with data collection.

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