Laparoscopic radiofrequency ablation of neuroendocrine liver metastases: a 10-year experience evaluating predictors of survival

doi:10.1016/j.surg.2007.01.036

Surgery

Volume 142, Issue 1, July 2007, Pages 10-19

https://doi.org/10.1016/j.surg.2007.01.036 Get rights and content

Background

A decade ago we reported the first use of laparoscopic radiofrequency thermal ablation (RFA) for the treatment of neuroendocrine hepatic metastases. This study analyzes our 10-year experience and determines characteristics predictive of survival.

Methods

Eighty RFA sessions were performed in 63 patients with neuroendocrine hepatic metastases in a prospective trial. All patients had unresectable disease with computed tomography (CT) documented lesion and/or symptom progression. Perioperative morbidity, symptom relief, disease progression, and long-term survival were analyzed. Data are expressed as mean ± standard error of the mean (SEM).

Results

There were 22 women and 41 men, age 54.4 ± 1.5 years followed for 2.8 ± 0.3 years (range, 0.1 to 7.8). Tumor types included 36 carcinoid, 18 pancreatic islet cell, and 9 medullary thyroid cancer. RFA was performed 1.6 ± 0.3 years after the diagnosis of liver metastases. Number of lesions treated was 6 ± 0.5 (range, 1 to 16). Forty-nine patients underwent 1 ablation session, and 14 (22%) had repeat sessions caused by disease progression. Mean hospital stay was 1.1 days. Perioperative morbidity was 5%, with no 30-day mortality. Fifty-seven percent of patients exhibited symptoms. One week postoperatively 92% of these reported at least partial symptom relief, and 70% had significant or complete relief. Duration of symptom control was 11 ± 2.3 months. CT follow-up demonstrated 6.3% local tumor recurrence. Larger dominant liver tumor size and male gender adversely impacted survival (P < .05). Median survival times were 11.0 years postdiagnosis of primary tumor, 5.5 years postdiagnosis of neuroendocrine hepatic metastases, and 3.9 years post-1st RFA. Survival for patients undergoing repeat ablation sessions was not significantly lower.

Conclusions

This study represents the largest series of neuroendocrine hepatic metastases treated by RFA. In this group of patients with aggressive neuroendocrine tumor metastases and limited treatment options, RFA provides effective local control with prompt symptomatic improvement.

Section snippets

Technique

We described our technique for laparoscopic RFA elsewhere.11, 12 In summary, the procedure is performed under general anesthesia. The patient is positioned supine on the operating table. We prefer to enter the abdominal cavity using an optical access trocar (Optiview, Ethicon Endo Surgery, Inc., Cincinnati, OH). The procedure is performed using two 11-mm trocars placed beneath the right costal margin. We first perform a diagnostic laparoscopy to rule out any extrahepatic disease. Then we

Results

Forty-one men and 22 women with 452 liver metastases underwent 80 laparoscopic RFA sessions. Mean age was 54.5 ± 1.5 years (range, 34 to 77). Eleven of the original 63 patients have had 2 ablation sessions, and 3 patients have undergone 3 RFA sessions.

The types and number of tumors treated were as follows: 36 carcinoid, of which 32 were gastrointestinal and 4 were bronchial in origin; 17 pancreatic islet cell (6 functional and 11 nonfunctional), 9 medullary thyroid cancer, and 1

Discussion

To our knowledge, this is the largest RFA series looking at the treatment of neuroendocrine liver metastases. We previously reported effective local tumor and symptom control with a low morbidity using laparoscopic RFA for neuroendocrine liver metastases.¹⁰ This report updates and expands our previously published series and defines prognostic factors for better patient selection.

Over the last decade, experience has shown RFA to be a valid option for patients with unresectable neuroendocrine

Conclusions

Our 10-year results for a large group of patients confirm that laparoscopic RFA provides efficient local tumor and symptom control in patients with neuroendocrine liver metastases. This study also defines dominant liver tumor size as a predictor of survival, which suggests that patients should be referred for RFA as early as possible. The results raised the specter of a worse prognosis for male patients, and further investigation into the role of more aggressive treatment for men with

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