{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,24]],"date-time":"2025-10-24T07:30:46Z","timestamp":1761291046527,"version":"3.37.3"},"reference-count":13,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2017,6,26]],"date-time":"2017-06-26T00:00:00Z","timestamp":1498435200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Journal of Surgical Oncology"],"published-print":{"date-parts":[[2017,12]]},"abstract":"<jats:sec><jats:title>Introduction<\/jats:title><jats:p>Management of neuroendocrine liver metastasis (NELM) in the presence of extrahepatic disease (EHD) is controversial. We sought to examine outcomes of patients undergoing liver\u2010directed therapy (resection, ablation, or both) for NELM in the presence of EHD using a large international cohort of patients.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>612 patients who underwent liver\u2010directed therapy were identified from eight institutions. Postoperative outcomes, as well as and overall (OS) were compared among patients with and without EHD.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Most primary tumors were located in the pancreas (<jats:italic>N<\/jats:italic>\u2009=\u2009254;41.8%) or the small bowel (<jats:italic>N<\/jats:italic>\u2009=\u2009188;30.9%). Patients underwent surgery alone (<jats:italic>N<\/jats:italic>\u2009=\u2009471;77.0%), ablation alone (<jats:italic>N<\/jats:italic>\u2009=\u200915;2.5%), or a combined approach (<jats:italic>N<\/jats:italic>\u2009=\u2009126;20.6%). Patients with EHD had more high\u2010grade tumors (EHD: 44.4% vs no EHD: 16.1%; <jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001). EHD was often the peritoneum (<jats:italic>N<\/jats:italic>\u2009=\u200929;41.4%) or lung (<jats:italic>N<\/jats:italic>\u2009=\u200919;27.1%). Among 70 patients with EHD, 20.0% (<jats:italic>N<\/jats:italic>\u2009=\u200914) underwent concurrent resection for EHD. After median follow\u2010up of 51 months, 174 (28.4%) patients died with a median OS of 140.4 months. Patients with EHD had a shorter median OS versus patients who did not have EHD (EHD: 87 months vs no EHD: not reached; <jats:italic>P<\/jats:italic>\u2009=\u20090.002). EHD was independently associated with an increased risk of death (HR: 2.56, 95%CI 1.16\u20105.62; <jats:italic>P<\/jats:italic>\u2009=\u20090.02).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Patients with NELM and EHD had more aggressive tumors, conferring a twofold increased risk of death. Surgical treatment of NELM among patients with EHD should be individualized.<\/jats:p><\/jats:sec>","DOI":"10.1002\/jso.24727","type":"journal-article","created":{"date-parts":[[2017,6,26]],"date-time":"2017-06-26T14:14:42Z","timestamp":1498486482000},"page":"841-847","source":"Crossref","is-referenced-by-count":14,"title":["The impact of extrahepatic disease among patients undergoing liver\u2010directed therapy for neuroendocrine liver metastasis"],"prefix":"10.1002","volume":"116","author":[{"given":"Aslam","family":"Ejaz","sequence":"first","affiliation":[{"name":"Department of Surgery Johns Hopkins Hospital Baltimore Maryland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Brad N.","family":"Reames","sequence":"additional","affiliation":[{"name":"Department of Surgery Johns Hopkins Hospital Baltimore Maryland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shishir","family":"Maithel","sequence":"additional","affiliation":[{"name":"Department of Surgery Emory University Atlanta Georgia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"George A.","family":"Poultsides","sequence":"additional","affiliation":[{"name":"Department of Surgery, School of Medicine Stanford University Stanford California"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Todd W.","family":"Bauer","sequence":"additional","affiliation":[{"name":"Department of Surgery University of Virginia Charlottesville Virginia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ryan C.","family":"Fields","sequence":"additional","affiliation":[{"name":"Department of Surgery, School of Medicine Washington University St Louis Missouri"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0553-248X","authenticated-orcid":false,"given":"Matt","family":"Weiss","sequence":"additional","affiliation":[{"name":"Department of Surgery Johns Hopkins Hospital Baltimore Maryland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hugo Pinto","family":"Marques","sequence":"additional","affiliation":[{"name":"Department of Surgery Curry Cabral Hospital Lisbon Portugal"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Luca","family":"Aldrighetti","sequence":"additional","affiliation":[{"name":"Department of Surgery, Liver Unit, Scientific Institute San Raffaele Vita\u2010Salute San Raffaele University Milan Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4828-8096","authenticated-orcid":false,"given":"Timothy M.","family":"Pawlik","sequence":"additional","affiliation":[{"name":"Division of Surgical Oncology The Ohio State University Comprehensive Cancer Center Columbus 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