Role of ablation therapy in conjunction with surgical resection for neuroendocrine tumors (NETs): Risks and benefits of multimodality surgical treatment for NETs involving liver

Background Resection of hepatic metastasis from neuroendocrine tumors (NETs) improves quality of life and prolongs 5-year survival. Ablation can be utilized with surgery to achieve complete resection. Although several studies report long-term outcomes for patients undergoing ablation, none have explored perioperative effects of ablation in patients with metastatic NETs. Our goal was to determine if intra-operative ablation during hepatectomy increases risk of adverse outcomes such as surgical site infections (SSIs), bleeding, and bile leak. Methods A retrospective analysis of the hepatectomy NSQIP database from 2015-2019 was performed to determine the odds of SSIs, bile leaks, or bleeding in patients undergoing intraoperative ablation when compared to hepatectomy alone. Results Of the 966 patients included in the study, 298(30.9%) underwent ablation during hepatectomy. There were 78(11.7%) patients with SSIs in the hepatectomy alone group and 39(13.1%) patients with a SSIs in the hepatectomy with ablation group. Bile leak occurred in 41(6.2%) and 14(4.8%) patients in the two groups, respectively; bleeding occurred in 117(17.5%) and 33(11.1%), respectively. After controlling for confounding variables, ablation did not increase risk of SSI (p=0.63), bile leak (p=0.34) or bleeding (p=0.07) when compared to patients undergoing resection alone on multivariate analysis. Conclusions Intraoperative ablation with hepatic resection for NETs is safe in the perioperative period without significant increased risk of infection, bleeding, or bile leak. Surgeons should utilize this modality when appropriate to achieve optimal disease control and outcomes.