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Metastatic Neuroendocrine Carcinoma

How feasible is the laparoscopic approach to liver resections?

Edwards L, White MJ Cawich SO, Abu Hilal M, Frola C, Pearce N


Background:

The feasibility and efficacy of laparoscopic liver resections are well documented, but there are no reports describing results in a dedicated cohort of patients with neuroendocrine tumours (NETs). We describe our experience of laparoscopic liver resection for NETs as part of a multimodal cytoreductive approach in a single centre NET tertiary referral unit.


Aim

To evaluate the feasibility of the laparoscopic approach to liver resections in metastatic NETs.


Methods

All patients assessed for metastatic intra-abdominal NETs from April 2005-October 2011 were prospectively registered on a database. Patients undergoing laparoscopic liver resection were identified. Demographic, peri-operative and survival data were analysed using SPSS version 12.0. Severity of operative and post-operative morbidity was graded using the Clavien system.


Results

The NET MDT assessed 239 patients. 99 patients had liver metastases and 58 underwent liver resection. 27 patients underwent 29 laparoscopic liver resections; 12 females, 15 males, median age 63 years (41–78). Intention of laparoscopic liver resection was either curative (n=4), cytoreductive (n=19) or diagnostic/staging (n=6). 11 major resections, 8 minor resections and 10 multiple metastectomies were performed.

Median post-operative stay was 4 days (0–12). 24 patients are alive after median 18.5 months (4-59) follow-up post surgery. 3 patients died of recurrence after median 20 months (16-25) follow-up post surgery.

There was no peri-operative mortality, with no cases of carcinoid crisis, bile leak or port site metastases. Of metastatic resections with no concurrent primary resection, 3 (10.3%) had post-operative complications (Grade I, II and IIIa morbidity).


Conclusion

This is the first series to demonstrate that laparoscopic liver resection for neuroendocrine metastases can be performed with low morbidity and mortality by experienced surgeons operating in a tertiary referral unit.

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