Impact of the extent of resection of neuroendocrine tumor liver metastases on survival: A systematic review and meta-analysis

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 sy...

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Autores principales: Kulkarni, Rugved, Kabir, Irfan, Hodson, James, Raza, Syed, Shah, Tahir, Pandanaboyana, Sanjay, Dasari, Bobby V. M.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: The Korean Association of Hepato-Biliary-Pancreatic Surgery 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8901984/
https://www.ncbi.nlm.nih.gov/pubmed/34980681
http://dx.doi.org/10.14701/ahbps.21-101
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author Kulkarni, Rugved
Kabir, Irfan
Hodson, James
Raza, Syed
Shah, Tahir
Pandanaboyana, Sanjay
Dasari, Bobby V. M.
author_facet Kulkarni, Rugved
Kabir, Irfan
Hodson, James
Raza, Syed
Shah, Tahir
Pandanaboyana, Sanjay
Dasari, Bobby V. M.
author_sort Kulkarni, Rugved
collection PubMed
description 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.
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spelling pubmed-89019842022-03-16 Impact of the extent of resection of neuroendocrine tumor liver metastases on survival: A systematic review and meta-analysis Kulkarni, Rugved Kabir, Irfan Hodson, James Raza, Syed Shah, Tahir Pandanaboyana, Sanjay Dasari, Bobby V. M. Ann Hepatobiliary Pancreat Surg Review Article 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. The Korean Association of Hepato-Biliary-Pancreatic Surgery 2022-02-28 2022-01-04 /pmc/articles/PMC8901984/ /pubmed/34980681 http://dx.doi.org/10.14701/ahbps.21-101 Text en Copyright © 2022 by The Korean Association of Hepato-Biliary-Pancreatic Surgery https://creativecommons.org/licenses/by-nc/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0 (https://creativecommons.org/licenses/by-nc/4.0/) ) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Review Article
Kulkarni, Rugved
Kabir, Irfan
Hodson, James
Raza, Syed
Shah, Tahir
Pandanaboyana, Sanjay
Dasari, Bobby V. M.
Impact of the extent of resection of neuroendocrine tumor liver metastases on survival: A systematic review and meta-analysis
title Impact of the extent of resection of neuroendocrine tumor liver metastases on survival: A systematic review and meta-analysis
title_full Impact of the extent of resection of neuroendocrine tumor liver metastases on survival: A systematic review and meta-analysis
title_fullStr Impact of the extent of resection of neuroendocrine tumor liver metastases on survival: A systematic review and meta-analysis
title_full_unstemmed Impact of the extent of resection of neuroendocrine tumor liver metastases on survival: A systematic review and meta-analysis
title_short Impact of the extent of resection of neuroendocrine tumor liver metastases on survival: A systematic review and meta-analysis
title_sort impact of the extent of resection of neuroendocrine tumor liver metastases on survival: a systematic review and meta-analysis
topic Review Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8901984/
https://www.ncbi.nlm.nih.gov/pubmed/34980681
http://dx.doi.org/10.14701/ahbps.21-101
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