Abstract
Management of Neuroendocrine liver metastases (NELM) is challenging. The presence of NELM worsens survival outcome and almost 10% of all liver metastases are neuroendocrine in origin. There is no firm consensus on the optimal treatment strategy for NELM. A systematic search of the PubMed database was performed from 1995–2010, to collate the current evidence and formulate a sound management algorithm. There are 22 case series with a total of 793 patients who had undergone surgery for NELM. The overall survival ranges from 46–86% at 5 years, 35–79% at 10 years, and the median survival ranges from 52–123 months. After successful cytoreductive surgery, the mean duration of symptom reduction is between 16–26 months, and the 5-year recurrence/progression rate ranges from 59–76%. Five studies evaluated the efficacy of a combination cytoreductive strategy reporting survival rate of ranging from 83% at 3 years to 50% at 10 years. To date, there is no level 1 evidence comparing surgery versus other liver-directed treatment options for NELM. An aggressive surgical approach, including combination with additional liver-directed procedures is recommended as it leads to long-term survival, significant long-term palliation, and a good quality of life. A multidisciplinary approach should be established as the platform for decision making.
Highlights
Neuroendocrine tumors (NETs) are a varied group of neoplasms characterized by a relatively slow growth rate and the potential to produce and secrete a variety of hormones along with other vasoactive substances, giving rise to a variety of clinical syndromes
We review the current literature and discuss on the surgical aspects of the management of neuroendocrine liver metastases
Due to the relative low incidence, the biological heterogeneity NETs, and Neuroendocrine liver metastases (NELM), there is a lack of prospective randomized studies providing level 1 evidence
Summary
Neuroendocrine tumors (NETs) are a varied group of neoplasms characterized by a relatively slow growth rate and the potential to produce and secrete a variety of hormones along with other vasoactive substances, giving rise to a variety of clinical syndromes. The incidence is increasing at a rate of 3% to 10% per year [4] This increase was likely caused in part by improvements in classification of these tumors, and the widespread use of endoscopy for cancer screening likely contributed to the increase in reported incidence of gastrointestinal NETs [3]. NETs are tumours of cells, which originate from the neuroectoderm and possess secretory granules They can occur as part of multiple endocrine neoplasia type 1 (MEN type I) syndrome, or more often they occur in isolation. They are classified according to their site of origin as foregut (including lung), midgut, or hindgut tumours. They can be classified as either functional tumors or as nonfunctional tumors [6, 7]
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