caa a22 4500 445338636 CHVBK 20180317142804.0 cr unu---uuuuu 170323e20111201xx s 000 0 eng 10.1245/s10434-011-1832-y doi (NATIONALLICENCE)springer-10.1245/s10434-011-1832-y Surgery Versus Intra-arterial Therapy for Neuroendocrine Liver Metastasis: A Multicenter International Analysis [Elektronische Daten] [Skye Mayo, Mechteld de Jong, Mark Bloomston, Carlo Pulitano, Bryan Clary, Srinevas Reddy, T. Clark Gamblin, Scott Celinski, David Kooby, Charles Staley, Jayme Stokes, Carrie Chu, David Arrese, Alessandro Ferrero, Richard Schulick, Michael Choti, Jean-Francois Geschwind, Jennifer Strub, Todd Bauer, Reid Adams, Luca Aldrighetti, Gilles Mentha, Lorenzo Capussotti, Timothy Pawlik] Background: Management of patients with neuroendocrine liver metastasis (NELM) remains controversial. We sought to examine the relative efficacy of surgical management versus intra-arterial therapy (IAT) for NELM and determine factors predictive of survival. Methods: A total of 753 patients who had surgery (n=339) or IAT (n=414) for NELM from 1985 to 2010 were identified from nine hepatobiliary centers. Clinicopathologic data were assessed with regression modeling and propensity score matching. Results: Most patients had a pancreatic (32%) or a small bowel (27%) primary tumor; 47% had a hormonally active tumor. There were statistically significant differences in characteristics between surgery versus IAT groups (hormonally active tumors: 28 vs. 48%; hepatic tumor burden >25%: 52% vs. 76%) (all P<0.001). Among surgical patients, most underwent hepatic resection alone without ablation (78%). The median number of IAT treatments was 1 (range, 1-4). Median and 5-year survival of patients treated with surgery was 123months and 74% vs. 34months and 30% for IAT (P<0.001). In the propensity-adjusted multivariate Cox model, asymptomatic disease (hazard ratio 2.6) was strongly associated with worse outcome (P=0.001). Although surgical management provided a survival benefit over IAT among symptomatic patients with >25% hepatic tumor involvement, there was no difference in long-term outcome after surgery versus IAT among asymptomatic patients (P=0.78). Conclusions: Asymptomatic patients with a large (>25%) burden of liver disease benefited least from surgical management and IAT may be a more appropriate treatment strategy. Surgical management of NELM should be reserved for patients with low-volume disease or for those patients with symptomatic high-volume disease. Society of Surgical Oncology, 2011 Mayo Skye Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA aut de Jong Mechteld Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA aut Bloomston Mark Department of Surgery, Ohio State University, Columbus, OH, USA aut Pulitano Carlo Ospedale San Raffaele, Milan, Italy aut Clary Bryan Duke Medical Center, Durham, NC, USA aut Reddy Srinevas Duke Medical Center, Durham, NC, USA aut Clark Gamblin T. University of Pittsburgh, Pittsburgh, PA, USA aut Celinski Scott University of Pittsburgh, Pittsburgh, PA, USA aut Kooby David Emory University School of Medicine, Atlanta, GA, USA aut Staley Charles Emory University School of Medicine, Atlanta, GA, USA aut Stokes Jayme University of Virginia, Charlottesville, VA, USA aut Chu Carrie Emory University School of Medicine, Atlanta, GA, USA aut Arrese David Department of Surgery, Ohio State University, Columbus, OH, USA aut Ferrero Alessandro Ospedale Mauriziano Umberto I, Turin, Italy aut Schulick Richard Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA aut Choti Michael Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA aut Geschwind Jean-Francois Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA aut Strub Jennifer Hôpitaux Universitaires de Genève, Geneva, Switzerland aut Bauer Todd University of Virginia, Charlottesville, VA, USA aut Adams Reid University of Virginia, Charlottesville, VA, USA aut Aldrighetti Luca Ospedale San Raffaele, Milan, Italy aut Mentha Gilles Hôpitaux Universitaires de Genève, Geneva, Switzerland aut Capussotti Lorenzo Ospedale Mauriziano Umberto I, Turin, Italy aut Pawlik Timothy Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA aut Annals of Surgical Oncology Springer-Verlag 18/13(2011-12-01), 3657-3665 1068-9265 18:13<3657 2011 18 10434 https://doi.org/10.1245/s10434-011-1832-y text/html Onlinezugriff via DOI 1 research-article jats NATIONALLICENCE 856 40 https://doi.org/10.1245/s10434-011-1832-y text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Mayo Skye Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA aut NATIONALLICENCE 700 1- de Jong Mechteld Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA aut NATIONALLICENCE 700 1- Bloomston Mark Department of Surgery, Ohio State University, Columbus, OH, USA aut NATIONALLICENCE 700 1- Pulitano Carlo Ospedale San Raffaele, Milan, Italy aut NATIONALLICENCE 700 1- Clary Bryan Duke Medical Center, Durham, NC, USA aut NATIONALLICENCE 700 1- Reddy Srinevas Duke Medical Center, Durham, NC, USA aut NATIONALLICENCE 700 1- Clark Gamblin T. University of Pittsburgh, Pittsburgh, PA, USA aut NATIONALLICENCE 700 1- Celinski Scott University of Pittsburgh, Pittsburgh, PA, USA aut NATIONALLICENCE 700 1- Kooby David Emory University School of Medicine, Atlanta, GA, USA aut NATIONALLICENCE 700 1- Staley Charles Emory University School of Medicine, Atlanta, GA, USA aut NATIONALLICENCE 700 1- Stokes Jayme University of Virginia, Charlottesville, VA, USA aut NATIONALLICENCE 700 1- Chu Carrie Emory University School of Medicine, Atlanta, GA, USA aut NATIONALLICENCE 700 1- Arrese David Department of Surgery, Ohio State University, Columbus, OH, USA aut NATIONALLICENCE 700 1- Ferrero Alessandro Ospedale Mauriziano Umberto I, Turin, Italy aut NATIONALLICENCE 700 1- Schulick Richard Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA aut NATIONALLICENCE 700 1- Choti Michael Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA aut NATIONALLICENCE 700 1- Geschwind Jean-Francois Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA aut NATIONALLICENCE 700 1- Strub Jennifer Hôpitaux Universitaires de Genève, Geneva, Switzerland aut NATIONALLICENCE 700 1- Bauer Todd University of Virginia, Charlottesville, VA, USA aut NATIONALLICENCE 700 1- Adams Reid University of Virginia, Charlottesville, VA, USA aut NATIONALLICENCE 700 1- Aldrighetti Luca Ospedale San Raffaele, Milan, Italy aut NATIONALLICENCE 700 1- Mentha Gilles Hôpitaux Universitaires de Genève, Geneva, Switzerland aut NATIONALLICENCE 700 1- Capussotti Lorenzo Ospedale Mauriziano Umberto I, Turin, Italy aut NATIONALLICENCE 700 1- Pawlik Timothy Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA aut NATIONALLICENCE 773 0- Annals of Surgical Oncology Springer-Verlag 18/13(2011-12-01), 3657-3665 1068-9265 18:13<3657 2011 18 10434 Metadata rights reserved Springer special CC-BY-NC licence nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-springer