A Multimodal Approach to the Management of Neuroendocrine Tumour Liver Metastases

Basuroy, Ron; Srirajaskanthan, Rajaventhan

doi:10.1155/2012/819193

Cited by 30 publications

(23 citation statements)

References 164 publications

(161 reference statements)

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“…90 requires input from a range of disciplines, including gastroenterology, surgery, histopathology, radiology, oncology and nuclear medicine. For this reason, cases should be discussed in a specialist NET multidisciplinary meeting (MDM) to ensure all investigation and treatment modalities are appropriately explored.…”

Section: Therapies In Advanced Diseasementioning

confidence: 99%

Review article: the investigation and management of gastric neuroendocrine tumours

Basuroy

Haji

Ramage

et al. 2014

Aliment Pharmacol Ther

124

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Summary Background Gastric carcinoids (GCs) or neuroendocrine tumours (NETs) are increasingly identified at endoscopy, and account for 0.6–2% of all gastric polyps identified. The SEER database in the US has demonstrated a rising incidence of gastric NETs amongst all NETs; from 2.2% between 1950 and 1969 to 6.0% between 2000 and 2007. Aim To review the literature and assist clinicians in managing patients with GCs. Methods A literature search was conducted through MEDLINE using search terms: gastric, carcinoid, neuroendocrine tumour, therapy, endoscopy, mucosal resection, submucosal dissection. Relevant articles were identified through manual review. The reference lists of these articles were reviewed to include further appropriate articles. Results There are three types of GCs with important epidemiological, pathophysiological, histological and endoscopic differences that affect prognosis and management. Type 1 and 2 GCs develop in the context of hypergastrinaemia that originates from achlorhydria in atrophic gastritis and a gastrinoma, respectively. Type 3 GCs occur sporadically and independent of gastrin. The histological type, grade and Ki67 index are used to determine prognosis and direct clinical management. Type 1 GCs >1 cm in size and type 2 GCs should be assessed for invasion beyond the submucosa with EUS prior to endoscopic resection with EMR or ESD. Type 3 GCs should be managed as per recommendations for gastric adenocarcinoma. The treatment of advanced disease is multimodal. Conclusions Patients with gastric carcinoids should be discussed in a specialist neuroendocrine tumour multidisciplinary meeting to ensure all treatment options are explored in localised and advanced disease. Areas of controversy exist that need further research.

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Section: Therapies In Advanced Diseasementioning

confidence: 99%

Review article: the investigation and management of gastric neuroendocrine tumours

Basuroy

Haji

Ramage

et al. 2014

Aliment Pharmacol Ther

124

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“…Intended curative surgery is only feasible in a minority (10%) of patients who present with metastatic disease [178,179]. Despite the fact that complete eradication of disease may often be unachievable, debulking/ cytoreductive surgery is still advocated because it improves symptoms caused by local invasion and catecholamine secretion.…”

Section: Surgerymentioning

confidence: 99%

Molecular and Therapeutic Advances in the Diagnosis and Management of Malignant Pheochromocytomas and Paragangliomas

et al. 2013

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Pheochromocytomas (PCCs) and paragangliomas (PGLs) are rare catecholamine-secreting tumors derived from chromaffin cells originating in the neural crest. These tumors represent a significant diagnostic and therapeutic challenge because the diagnosis of malignancy is frequently made in retrospect by the development of metastatic or recurrent disease. Complete surgical resection offers the only potential for cure; however, recurrence can occur even after apparently successful resection of the primary tumor. The prognosis for malignant disease is poor because traditional treatment modalities have been limited. The last decade has witnessed exciting discoveries in the study of PCCs and PGLs; advances in molecular genetics have uncovered hereditary and germline mutations of at least 10 genes that contribute to the development of these tumors, and increasing knowledge of genotype-phenotype interactions has facilitated more accurate determination of malignant potential. Elucidating the molecular mechanisms responsible for malignant transformation in these tumors has opened avenues of investigation into targeted therapeutics that show promising results. There have also been significant advances in functional and radiological imaging and in the surgical approach to adrenalectomy, which remains the mainstay of treatment for PCC. In this review, we discuss the currently available diagnostic and therapeutic options for patients with malignant PCCs and PGLs and detail the molecular rationale and clinical evidence for novel and emerging diagnostic and therapeutic strategies. TheOncologist2013; 18:391-407 Implications for Practice: Malignant pheochromocytoma and paraganglioma represent a significant management challenge.The diagnosis of malignancy is frequently made in retrospect and traditional treatment modalities have been limited. Recent exciting advances in molecular genetics have uncovered hereditary and germline mutations of at least 10 genes that contribute to the development of these tumors. Increasing knowledge of genotype-phenotype interactions facilitates more accurate determination of malignant potential and has prompted investigation into targeted therapeutics with promising results. There have also been significant advances in functional and radiological imaging and in the surgical approach to adrenalectomy, which remains the mainstay of treatment for pheochromocytoma. Due to the rarity of this tumor, large-scale clinical studies that would progress clinical practice are rare, and the requirement for international collaboration is crucial. The need for large-scale international multicenter studies to effectively exploit the molecular and genetic knowledge gained in this area is highlighted in this review.

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“…10,11 When it is feasible, aggressive surgical management of both the primary tumor and liver metastases improve survival rate extensively. 10,12,13,14 The minimal invasive surgical approach to pancreatic neoplasm leads to many benefits, including recovery cosmetic results, lower perioperative complication, early access to adjuvant therapies, and psychological implication. 15 After the first robotic distal pancreatectomy reported by Melvin et al 16 in 2003, robotic surgical systems exhibit several advantages over conventional laparoscopic instrumentations.…”

Section: Introductionmentioning

confidence: 99%

The First Case Report of Robotic Multivisceral Resection for Synchronous Liver Metastasis from Pancreatic Neuroendocrine Tumor: A Case Report and Literature Review

Calin

Sadiq

Arevalo

et al. 2016

Journal of Laparoendoscopic & Advanced Surgical Techniques

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Liver metastases in PNETs are considered an adverse factor. Aggressive surgical management is a mainstay. The laparoscopic approach to pancreatic or hepatic surgery is difficult in inexperienced hands with steep learning curve. The recent robotic system seems to overcome many limitations. This is the first case of robotic multivisceral resection for synchronous liver metastasis from PNET. Concurrent primary tumor resection with hepatectomy offers potential curative intention.

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A Multimodal Approach to the Management of Neuroendocrine Tumour Liver Metastases

Cited by 30 publications

References 164 publications

Review article: the investigation and management of gastric neuroendocrine tumours

Review article: the investigation and management of gastric neuroendocrine tumours

Molecular and Therapeutic Advances in the Diagnosis and Management of Malignant Pheochromocytomas and Paragangliomas

The First Case Report of Robotic Multivisceral Resection for Synchronous Liver Metastasis from Pancreatic Neuroendocrine Tumor: A Case Report and Literature Review

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