Neuroendocrine carcinomas: Optimal surgery of peritoneal metastases (and associated intra-abdominal metastases)

Aim. To report the results of complete cytoreductive surgery (CCRS) of peritoneal metastases from neuroendocrine tumor (NET) and to compare patients treated with or without hyperthermic intraperitoneal chemotherapy (HIPEC). Background. Aggressive management of peritoneal metastases from NET (in most of the cases associated with other types of metastases) has not been addressed in the literature, but these metastases affect overall survival. Patients and methods. From 1994 to 2012, 41 patients underwent CCRS, with HIPEC (n = 28) from 1994 to 2007 but without HIPEC (n = 13) from 2008 to 2012. Liver metastases were treated during the same operative procedure in 66% of the patients. Results. Mortality was 2% and morbidity 56%. Overall survival at 5 and 10 years was 69% and 52%, respectively, and disease-free survival at 5 and 10 years was 17% and 6%, respectively. At 5 years, peritoneal metastases and liver metastases recurred in 47% and in 66% of cases, respectively. Overall survival was not different between patients treated with or without HIPEC, but disease-free survival was greater in the HIPEC group (P = .018), mainly because of fewer lung and bone metastases. Conclusion. CCRS of peritoneal metastases from a NET is feasible in most of the patients and seems to increase survival rates. We were unable to determine whether adding HIPEC had a positive or a negative impact.