Abstract
Neuroendocrine neoplasms (NENs) are a distinctive entity, and nearly 10% of patients already have liver metastases at presentation. The management of neuroendocrine liver metastases (NEN-LM) is complex with differing patterns of metastatic presentation. An aggressive approach should be used to resect the primary tumor, to remove regional lymph nodes, and to resect or treat appropriate distant metastases (including liver tumors). Despite having an indolent course, NENs have a significantly reduced survival when liver metastases are untreated. Though a wide range of therapies are now available with a multimodal approach to the treatment, surgical treatment offers the only chance for a significant survival prolongation and/or improvement of symptoms and quality of life. A review of the existing surgical modalities for NEN-LM is discussed in this paper.
Highlights
Neuroendocrine tumors (NETs) consist of a group of neoplasms that arise from neuroendocrine cells dispersed throughout the body and show variable clinical course
It is recognized that all neuroendocrine tumours are potentially malignant and characterized as neuroendocrine neoplasms (NENs)
In contrast with the traditional opinion that NEN represents an indolent disease, Touzios et al [10] reported 5year survivals range from 13–54% in patients with untreated NENs present with liver metastases (NEN-LM) compared to 75–99% in those without liver metastases [11,12,13,14,15]
Summary
Neuroendocrine tumors (NETs) consist of a group of neoplasms that arise from neuroendocrine cells dispersed throughout the body and show variable clinical course. It is recognized that all neuroendocrine tumours are potentially malignant and characterized as neuroendocrine neoplasms (NENs). Up to 75% of patients with small bowel NEN and 30–85% of pancreatic NENs present with liver metastases (NEN-LM) either at initial evaluation or during the course of their disease [7,8,9]. An additional 5–10% of NEN patients present with liver metastases with unknown primary tumor site. In contrast with the traditional opinion that NEN represents an indolent disease, Touzios et al [10] reported 5year survivals range from 13–54% in patients with untreated NEN-LM compared to 75–99% in those without liver metastases [11,12,13,14,15]
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