Parenchyma-Sparing Hepatic Cytoreduction for Neuroendocrine Tumours Metastases

Abstract

Background: Due to unique indolent biology, metastatic neuroendocrine tumours (NETs) can be managed for many years with prolonged survival. Goals of NETs therapy differ from other more common solid malignancies. Cytoreductive surgery plays an important role in the multidisciplinary management of low-grade NETs. It offers an opportunity to reduce both tumor burden and hormonal load to potentially prolong survival and improve quality of life. While parenchyma-sparing cytoreduction is the recommended technique, anatomical resections are still commonly performed because they are more familiar to liver surgeons. Methods: This video reviews parenchyma-sparing cytoreductive surgery of hepatic NETs metastases. Approaches and techniques, with their rationale are reviewed. Results: We focus on the management of hepatic metastases in grade 1 and 2 NETs. The video reviews the principles of parenchyma-sparing cytoreduction with enucleation, hepatotomy, and intra-operative ablation. Considering the goal of cytoreduction for an indolent disease, R1 or R2 resection is planned. We highlight the need to avoid anatomical resection to preserve parenchyma, which is critical in minimizing morbidity and optimizing long-term sequencing of therapies for a chronic cancer. Conclusion: We herein illustrate the rationale and principles for hepatic parenchyma-sparing cytoreduction for metastatic NETs. This approach can lead to significant tumoral and hormonal control, with favorable long-term outcomes. Using a parenchyma sparing approach rather than anatomic resections may improve long term function and preserve the ability to tolerate future liver directed therapy. Review and dissemination of the technique will contribute to safe surgical management of metastatic NETs by hepato-pancreatico-biliary surgeons.