Surgical strategy and selection criteria for patients with neuroendocrine liver metastasis: Personal experience with 340 patients

Abstract

The role of surgical treatment of liver metastasis from neuroendocrine neoplasm (NEN) is still a debated issue and, in absence of official guidelines, 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 untreated patients or other liver directed therapy (Intra-arterial procedures in particular). Many authors assert that locoregional procedure achieve the same results in prognosis compared to surgery, in front of less invasive approach. Despite this, most of retrospective studies in literature confirm that hepatic resection, supported by liver directed therapies, gives the best results survival rate and symptoms control, and it is the main treatment adopted in many centers. Patients with advanced NEN are highly heterogeneous in clinical presentation, and can benefit from a wide panel of therapeutic strategy, with different modality based on metastatic pattern and clinical features. The aim of this work is to resume the main surgical strategy and selection criteria adopted and to achieve a flow chart for a personalized management of these patients based on authors experience that includes 340 patients with a histologically proven NEN.