Cause of death after cytoreductive hepatectomy for neuroendocrine tumor liver metastases: a single center retrospective analysis

Vanja Podrascanin; Markus Ammann; Hallbera Gudmundsdottir; Yawen Dong; Zhihao Li; Cornelius A Thiels; Susanne G Warner; Mark J Truty; Michael L Kendrick; Rory L Smoot; Sean P Cleary; Thorvardur R Halfdanarson; David M Nagorney; Patrick P Starlinger

doi:10.1016/j.ejso.2025.110258

Cause of death after cytoreductive hepatectomy for neuroendocrine tumor liver metastases: a single center retrospective analysis

Eur J Surg Oncol. 2025 Jun 21;51(9):110258. doi: 10.1016/j.ejso.2025.110258. Online ahead of print.

Affiliations

¹ Department of Surgery, Division of Hepatobiliary and Pancreas Surgery, Mayo Clinic, Rochester, MN, USA; Department of Surgery, University Hospital Wiener Neustadt, Wiener Neustadt, Austria.
² Department of Surgery, Division of Hepatobiliary and Pancreas Surgery, Mayo Clinic, Rochester, MN, USA.
³ Department of Surgery, Division of Hepatobiliary and Pancreas Surgery, Mayo Clinic, Rochester, MN, USA; Department of Surgery, HPB Center, Vienna Health Network, Clinic Favoriten and Sigmund Freud Private University, Vienna, Austria.
⁴ Department of Surgery, Division of Hepatobiliary and Pancreas Surgery, Mayo Clinic, Rochester, MN, USA; Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Canada.
⁵ Division of Medical Oncology, Department of Oncology, Mayo Clinic, Rochester, MN, USA.
⁶ Department of Surgery, Division of Hepatobiliary and Pancreas Surgery, Mayo Clinic, Rochester, MN, USA. Electronic address: starlinger.patrick@mayo.edu.

PMID: 40570590
DOI: 10.1016/j.ejso.2025.110258

Abstract

Introduction: Over the past three decades, overall survival for neuroendocrine tumor liver metastases (NETLM) has improved. However, the slow-growing nature of well-differentiated NETLM necessitates understanding and characterization of tumor-related causes of death. Examining long-term outcomes following cytoreductive hepatectomy for NETLM, we aimed to determine how many patients die from their NETs (tumor related death - TRD) versus other causes (non-tumor related death - NTRD).

Methods: Patients who underwent hepatic resection for NETLM at Mayo Clinic Rochester from 2000 to 2020 were analyzed. Mortalities were stratified into TRD and NTRD through detailed analysis of deceased patients.

Results: A total of 567 patients underwent a hepatectomy for well-differentiated NETLM over the 20 years of study period, 146 were lost of follow up and 187 were included. Of these deceased patients, 71 % experienced TRD, with liver failure (47 %) and small bowel obstruction due to peritoneal carcinomatosis (20 %) as the leading causes. NTRD causes varied, including secondary malignancies, stroke, and ulcer perforation. Significant predictors for TRD included age, progression-free survival, and Grade 3 NETLM, with 92 % of patients with G3 NETLMs suffering from TRD (p = 0.035). Notably, in patients surviving >10 years post-hepatectomy, TRD rates declined, while NTRD increased.

Conclusion: These data indicate that after cytoreductive hepatectomy for NETLM about 1/3 of patients did not die from the disease itself. With increasing time after surgical intervention, the proportion of patients dying from NTRD did rise. Notably, younger patients, earlier postoperative recurrences and G3 NETLMs were more likely to suffer from TRD.

Keywords: Hepatic resection; Postoperative survival; Tumor related death; Well-differentiated neuroendocrine liver metastasis; non tumor related death.