Surgery Provides Long-Term Survival in Patients with Metastatic Neuroendocrine Tumors Undergoing Resection for Non-Hormonal Symptoms

IntroductionPatients with metastatic neuroendocrine tumor (NET) often have an indolent disease course yet the outcomes for patients with metastatic NET undergoing surgery for non-hormonal (NH) symptoms of GI obstruction, bleeding, or pain is not known.MethodsWe identified patients with metastatic gastroenteropancreatic NET who underwent resection from 2000 to 2016 at 8 academic institutions who participated in the US Neuroendocrine Tumor Study Group.ResultsOf 581 patients with metastatic NET to liver (61.3%), lymph nodes (24.1%), lung (2.1%), and bone (2.5%), 332 (57.1%) presented with NH symptoms of pain (n=223, 67.4%), GI bleeding (n=54, 16.3%), GI obstruction (n=49, 14.8%), and biliary obstruction (n=22, 6.7%). Most patients were undergoing their first operation (85.4%) within 4weeks of diagnosis. The median overall survival was 110.4months, and operative intent predicted survival (p<0.001) with 66.3% undergoing curative resection. Removal of all metastatic disease was associated with the longest median survival (112.5months) compared to debulking (89.2months), or palliative resection (50.0months; p<0.001). The 1-, 3-, and 12-month mortality was 3.0%, 4.5%, and 9.0%, respectively. Factors associated with 1-year mortality included palliative operations (OR 6.54, p=0.006), foregut NET (5.62, p=0.042), major complication (4.91, p=0.001), and high tumor grade (11.2, p<0.001). The conditional survival for patients who lived past 1year was 119months.ConclusionsPatients with metastatic NET and NH symptoms that necessitate surgery have long-term survival, and goals of care should focus on both oncologic and quality of life impact. Surgical intervention remains a critical component of multidisciplinary care of symptomatic patients.