Surgical strategies and selection criteria for patients with liver metastasis from neuroendocrine tumors: personal experience

Abstract

Background: The role of surgical treatment of liver metastasis from neuroendocrine neoplasm(NET)is still a debated issue, and the management of these patients is entrusted to the practical experience of single centers. The main problem is that there are not available randomized trials comparing surgical resection to unthreated patients or other liver directed therapy. The aim of this work is to resume the main surgical strategies and selection criteria adopted and compare the results to our experience to achieve a flow chart for a personalized management of these patients Methods: between 2005 and 2015, 284 patients with histologic diagnosis of NET afferent to Ca’Foncello Hospital in Treviso were collected. In this group,119 cases of gastro-entero-pancreatic NET(GEP-NET)were identified,37of them with liver metastasis Results: Among 37patients with NET liver metastasis,9 underwent surgical resection. Statistical analysis demonstrated a better overall survival of resected patients(p=0.035). Furthermore, poor differentiated NET(G3)presented worse prognosis than well differentiated(G1/G2)NET, and the same results were obtained considering Ki67 values alone(p=0.0001) Conclusion: Data evaluation suggests that surgery has so far the best results in the treatment of NET liver metastasis, especially when associated to ablative procedures.Patients with advanced NEN are highly heterogeneous, and can benefit from a wide panel of therapeutic strategy, with different modality based on grading, metastatic pattern and clinical features