Surgery · 2026
Surgical liver debulking and bland embolization for controlling liver metastases in patients with neuroendocrine tumors: A comparative effectiveness analysis.
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Lu Patricia G, Tobias Joseph, Appelbaum Daniel, Feinberg Nicholas, Memeh Kelvin, Khan Abdul, Kumari Divya, Patel Mikin, Ahmed Osman, Millis J Michael, Liao Chih-Yi Andy, Keutgen Xavier M
Аннотация
BACKGROUND: Surgical liver debulking and bland embolization (transarterial embolization) are commonly used to control progression of neuroendocrine tumor liver metastases. We sought to determine what sequence of surgical debulking and transarterial embolization provided longer disease control.
METHODS: We conducted a retrospective single-center cohort study to create a comparative effectiveness analysis model of surgical debulking and transarterial embolization. Inverse probability of treatment weighting was estimated from primary tumor site, Ki-67, liver tumor volume, and extrahepatic metastases to balance treatment groups. Weighted Kaplan-Meier analyses were used to estimate median progression-free survival.
RESULTS: Among 78 patients with neuroendocrine tumor liver metastases (34 small bowel, 29 pancreas, and 15 other), 24 (31%) underwent surgical debulking only, 23 (30%) surgery followed by transarterial embolization, 26 (33%) transarterial embolization only, and 5 (6%) transarterial embolization followed by surgery. Compared with patients who underwent surgery, transarterial embolization-only patients were more likely to have Ki-67 >20% (26.9% vs 9.6%, P = .03) and greater liver tumor burden (median tumor volume, 231 mL versus 150 mL, P = .04). After inverse probability of treatment weighting, covariate balance improved substantially. Weighted median progression-free survival was 13 months for surgery only or surgery first (95% confidence interval, 12-19) versus 9 months for embolization only or embolization first (95% confidence interval, 5-30, P = .003). Serotonin levels decreased significantly after surgery (1,170 to 434 ng/mL, P = .027) but not after embolization (1,873-1,445 ng/mL, P = .31).
CONCLUSION: Neuroendocrine tumor liver metastases patients who were treated with surgical liver debulking first had longer progression-free survival. Surgery should be considered first line in appropriately selected patients, with transarterial embolization reserved for recurrent or unresectable disease.
METHODS: We conducted a retrospective single-center cohort study to create a comparative effectiveness analysis model of surgical debulking and transarterial embolization. Inverse probability of treatment weighting was estimated from primary tumor site, Ki-67, liver tumor volume, and extrahepatic metastases to balance treatment groups. Weighted Kaplan-Meier analyses were used to estimate median progression-free survival.
RESULTS: Among 78 patients with neuroendocrine tumor liver metastases (34 small bowel, 29 pancreas, and 15 other), 24 (31%) underwent surgical debulking only, 23 (30%) surgery followed by transarterial embolization, 26 (33%) transarterial embolization only, and 5 (6%) transarterial embolization followed by surgery. Compared with patients who underwent surgery, transarterial embolization-only patients were more likely to have Ki-67 >20% (26.9% vs 9.6%, P = .03) and greater liver tumor burden (median tumor volume, 231 mL versus 150 mL, P = .04). After inverse probability of treatment weighting, covariate balance improved substantially. Weighted median progression-free survival was 13 months for surgery only or surgery first (95% confidence interval, 12-19) versus 9 months for embolization only or embolization first (95% confidence interval, 5-30, P = .003). Serotonin levels decreased significantly after surgery (1,170 to 434 ng/mL, P = .027) but not after embolization (1,873-1,445 ng/mL, P = .31).
CONCLUSION: Neuroendocrine tumor liver metastases patients who were treated with surgical liver debulking first had longer progression-free survival. Surgery should be considered first line in appropriately selected patients, with transarterial embolization reserved for recurrent or unresectable disease.