Parenchymal sparing liver resection for cytoreduction of neuroendocrine tumors metastases

Abstract

BackgroundDue to unique indolent biology, neuroendocrine tumors (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 NETs. It offers an opportunity to reduce both tumor burden and hormonal load to improve symptom-free survival and quality of life, and spare systemic therapy options. Parenchyma-sparing liver cytoreduction is recommended technique to preserve liver parenchyma for future treatments upon progression or recurrence. MethodsThis video reviews parenchyma-sparing cytoreductive surgery for NETs liver metastases. Approaches and techniques, and their rationale are reviewed. ResultsWe focus on the management of hepatic metastases in well differentiated low grade intestinal neuroendocrine neoplasm (or NET). The video reviews the steps of parenchyma-sparing liver metastases with enucleation for NETs. Considering the goal for cytoreduction for an indolent disease, wide margins are not aimed for. We highlight the technical aspects of enucleations to avoid anatomical resection and preserve parenchyma, which is critical in minimizing morbidity and optimizing long-term sequencing of therapies for a chronic malignancy. ConclusionWe herein illustrate the steps and rationale for hepatic parenchyma-sparing cytoreduction for metastatic NETs. This approach can lead to significant tumoral and hormonal control, with favorable long-term outcomes. Parenchyma-sparing resection should be used over anatomical resection.